Do the benefits of analog insulins justify their costs?

Abstract

173 ISSN 1758-1907 10.2217/DMT.12.17 © 2012 Future Medicine Ltd Diabetes Manage. (2012) 2(3), 173–175 Diabetes mellitus is a chronic condition that affects 346 million people worldwide and more than 80% of people with diabetes live in low-to-middle income countries [101]. The aim of treatment is to reduce the symptoms of diabetes and reduce blood glucose levels as uncontrolled hyper glycemia is associated with an increased risk of macrovascular and microvascular complications. Patients with Type 1 diabetes always require treatment with exogenous insulin. For Type 2 diabetes, treatment options begin with diet modification and lifestyle interventions but often oral hypoglycaemic agents or insulin or both are required as the disease progresses. Currently, there are three different types of insulin by molecular origin on the market. From oldest to newest, these are animal insulin, human insulin and analog insulin. Human insulin was introduced in the 1980s and was thought to be less immunogenic than animal insulin, thus, leading to lower antibody titers. However, no clinically relevant differences, in terms of adverse effects or glycemic control between animal (particularly purified porcine insulin) and human insulin, could be detected [1]. Despite this, human insulin was used routinely and the use of animal insulin declined rapidly [1,2]. By 2000, the National Health Service (NHS) in the UK was spending £102.1 million per year on human insulin but just £7.4 million on animal insulin at 2010 prices [3]. In developing countries there was concern that human insulin would be unaffordable and that the major insulin manufacturers would stop producing animal insulin, thus, leading to a shortage [1]. Insulin analogs were developed through structural modification of human-sequence insulin to better mimic the pharmacokinetic profile of endogenous insulin. Since their launch, insulin analogs have had an increasing impact on the amount of money the NHS spends on diabetes [3]. In the UK, the overall NHS spend on insulin doubled between 2000 and 2010. In 2000, human insulin accounted for 85% of the total cost of insulin, whereas insulin analogs accounted for just 12%. By 2010, this situation had reversed, and sales of analog insulin dominated the market [3]. The popularity of insulin analogs could be due in part to successful marketing. In