Stratification of direct retail pharmacotherapy costs for type 2 diabetes mellitus and obesity in Russia: an analysis of guideline-recommended regimens

Objective: To calculate direct retail pharmacotherapy and monitoring costs for type 2 diabetes mellitus (T2DM) and obesity in adults in the Russian Federation based on the current Ministry of Health clinical guidelines.

Material and methods. Using median retail prices from the apteka.ru and uteka.ru pharmacy aggregators in April 2026, costs for 14 T2DM and 5 obesity pharmacotherapy regimens were calculated. The dataset included 254 price items for T2DM drugs and 44 items for obesity drugs. The analysis was conducted from the perspective of the patient as a retail market consumer. Direct non-drug medical monitoring costs, including laboratory tests, physician visits, and self-monitoring of blood glucose, were additionally assessed.

Results. T2DM pharmacotherapy costs ranged from 175 to 14,716 rubles per month, corresponding to an approximately 84-fold difference between the least and most expensive regimens. Three cost strata were identified: (I) low-cost (<500 rubles per month); (II) medium-cost (1,000–7,000 rubles per month); and (III) high-cost (>12,000 rubles per month) strata. Low-cost regimens included metformin and its combinations with sulfonylureas; medium-cost regimens included dipeptidyl peptidase-4 inhibitors, sodium-glucose transport-2 inhibitors, insulin and injectable semaglutide; high-cost regimens included liraglutide, tirzepatide, and oral semaglutide. Obesity pharmacotherapy costs ranged from 2,958 rubles per month for sibutramine to 29,568 rubles per month for semaglutide (2.4 mg once a week). The total annual recommended monitoring costs including self-monitoring of blood glucose reached 32,900–63,200 rubles for patients receiving oral therapy and 51,150–99,700 rubles for patients receiving insulin studies.

Conclusion. Transition to modern pharmacotherapy regimens for T2DM and obesity is associated with a substantial increase in direct drug expenditure. Injectable semaglutide belongs to the medium-cost stratum, whereas oral semaglutide remains in the high-cost stratum, which may reflect the technological complexity of the oral salcaprozate sodium formulation and limited competition in this segment. Accounting for monitoring costs shows that the true direct financial burden on patients substantially exceeds drug costs, particularly in the low- and medium-cost strata. These data provide a basis for subsequent pharmacoeconomic analyses.

1. Dedov I.I., Shestakova M.V., Vikulova O.K., et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes Mellitus for the period 2010–2022. Diabetes Mellitus. 2023; 26 (2): 104–23 (in Russ.). https://doi.org/10.14341/DM13035.

2. Magliano D., Boyko E.J. Diabetes atlas. 11th ed. International Diabetes Federation; 2025: 125 pp.

3. Dedov I.I., Shestakova M.V., Galstyan G.R. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016; 19 (2): 104–12 (in Russ.). https://doi.org/10.14341/DM2004116-17.

4. Healthcare in Russia. 2025. Statistical digest. Мoscow: Rosstat; 2025: 149 pp. (in Russ.).

5. Balanova Yu.A., Drapkina O.M., Kutsenko V.A., et al. Obesity in the Russian population during the COVID-19 pandemic and associated factors. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023; 22 (8S): 3793 (in Russ.). https://doi.org/10.15829/1728-8800-2023-3793.

6. Dedov I.I., Mokrysheva N.G., Melnichenko G.A., et al. Clinical recommendations “Gestational diabetes mellitus” of the Russian Ministry of Health. Version of the year 2024. Bulletin of Reproductive Health. 2025; 4 (2): 14–30 (in Russ.). https://doi.org/10.14341/brh12763.

7. Kontsevaya A., Shalnova S., Deev A., et al. Overweight and obesity in the Russian population: prevalence in adults and association with socioeconomic parameters and cardiovascular risk factors. Obes Facts. 2019; 12 (1): 103–14. https://doi.org/10.1159/000493885.

8. Lee A.A., Khotina V.A., Kashirskikh D.A., et al. Incretin-based therapies through the decades: molecular innovations and clinical impact. Med Sci. 2025; 13 (4): 269. https://doi.org/10.3390/medsci13040269.

9. Dedov I.I., Koncevaya A.V., Shestakova M.V., et al. Economic evaluation of type 2 diabetes mellitus burden and its main cardiovascular complications in the Russian Federation. Diabetes Mellitus. 2016; 19 (6): 518–27 (in Russ.). https://doi.org/10.14341/DM8153.

10. Suntsov Yu.I., Dedov I.I. The State Register of Diabetes Patients is the main information system for calculating the state's economic costs for diabetes and forecasting them. Diabetes Mellitus. 2005; 8 (2): 2–5. https://doi.org/10.14341/2072-0351-5773.

11. Lee Y., Lim S., Davies M.J. Cardiometabolic and renal benefits of sodium-glucose cotransporter 2 inhibitors. Nat Rev Endocrinol. 2025; 21 (12): 783–98. https://doi.org/10.1038/s41574-025-01170-4.

12. Kurkin D.V., Makarova E.V., Zvereva V.I., et al. Dynamics of turnover of sugar-lowering drugs in the retail segment of the pharmaceutical market from 2020 to 2024. Pharmacy & Pharmacology. 2025; 13 (2): 84–97 (in Russ.). https://doi.org/10.19163/2307-9266-2025-13-2-84-97.

13. Zyryanov S.К., Dyakov I.N. Economic effectiveness of fixed-dose combination of alogliptin and pioglitazone in diabetes mellitus treatment. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2024; 17 (4): 442–52 (in Russ.). https://doi.org/10.17749/2070-4909/farmakoekonomika.2024.290.

14. Petrukhina I.K., Lazarev A.M., Ryazanova T.K., et al. Features of population consumption of combined glucose-lowering drugs in pharmacy organizations of the Russian Federation. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2026; 19 (1): 110–21 (in Russ.). https://doi.org/10.17749/2070-4909/farmakoekonomika.2026.323.

15. Rubricator of clinical guidelines. Type 2 diabetes in adults. 2022. Available at: https://cr.minzdrav.gov.ru/view-cr/290_2 (in Russ.) (accessed 24.04.2026).

16. Rubricator of clinical guidelines. Obesity. 2024. Available at: https://cr.minzdrav.gov.ru/view-cr/28_3 (in Russ.) (accessed 24.04.2026).

17. Zinman B., Wanner C., Lachin J.M. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373 (22): 2117–28. https://doi.org/10.1056/NEJMoa1504720.

18. Wiviott S.D., Raz I., Bonaca M.P., et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380 (4): 347–57. https://doi.org/10.1056/NEJMoa1812389.

19. Zinman B., Nauck M.A., Bosch-Traberg H., et al Liraglutide and glycaemic outcomes in the LEADER trial. Diabetes Ther. 2018; 9 (6): 2383–92. https://doi.org/10.1007/s13300-018-0524-z.

20. Marso S.P., Bain S.C., Consoli A. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016; 375 (19): 1834–44. https://doi.org/10.1056/NEJMoa1607141.

21. McGuire D.K., Marx N., Mulvagh S.L., et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med. 2025; 392 (20): 2001–12. https://doi.org/10.1056/NEJMoa2501006.

22. Nicholls S.J., Pavo I., Bhatt D.L. Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes. N Engl J Med. 2025; 393 (24): 2409–20. https://doi.org/10.1056/NEJMoa2505928.

23. Aroda V.R., Blonde L., Pratley R.E. A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes. Rev Endocr Metab Disord. 2022; 23 (5): 979–94. https://doi.org/10.1007/s11154-022-09735-8.

24. Salukhov V.V., Galstyan G.R., Ilyinskay T.A. Practical aspects of initiation and use of SGLT2 inhibitors: inpatient and outpatient perspectives. Diabetes Mellitus. 2022; 25 (3): 275–87 (in Russ.). https://doi.org/10.14341/DM12855.

25. Rangaswami J., Bhalla V., de Boer I.H. Cardiorenal protection with the newer antidiabetic agents in patients with diabetes and chronic kidney disease: a scientific statement from the American Heart Association. Circulation. 2020; 142 (17): e265–86. https://doi.org/10.1161/CIR.0000000000000920.

26. Omelyanovskiy V.V., Avxentyeva M.V., Sura M.V., Ivakhnenko O.I. Methodological recommendations for calculating costs during clinical and economic studies of drugs. Available at: https://cloud.corp.rosmedex.ru/s/KXGQZjsNQ3yZmqe/download/Metodicheskie-rekomendatsii-po-raschetu-zatrat-pri-provedenii-kliniko-e%60konomicheskih-issledovaniy-lekarstvennyih-preparatov-2017.pdf (on Russ.) (accessed 24.04.2026).