Utilization and expenditure on long-acting insulin analogs among selected middle-income countries with high patient co-payment levels: Findings and implications for the future

Akter Farhana,Abubakar Abdullahi Rabiu,Opanga Sylvia,Sani Ibrahim Haruna,Islam Salequl,Haque Mainul,Godman Brian,Kamal Zubair Mahmood

doi:10.7324/japs.2021.110720

Abstract

The number of patients with diabetes and associated complications is rising across countries including patients requiring insulin to control their diabetes. Hypoglycaemia combined generally with poor control adds to the burden of diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia, including nocturnal hypoglycaemia, and enhance adherence, which can be a problem. These benefits have resulted in increased use among high and high-middle income countries, which is continuing. However, concerns in middle and lower-income countries as insulin analogues are considerably more expensive than standard insulins. Biosimilars can reduce their costs. Consequently, important to ascertain current usage and prices of analogues across middle-income countries with high patient co-payment levels to provide future direction. Overall, limited use of insulin glargine in Kenya up to 3.6% of total insulins in one leasing hospital with prices up to 3.4 fold higher than standard insulins. Overall, limited use of insulin glargine among hospitals in Northern Nigeria and in pharmacies again due to high prices. Appreciably higher use of long-acting insulin analogues in Bangladesh enhanced by low cost biosimilars with increasing competition. Increased competition enhanced by local production can lower biosimilar costs enhancing future use of insulin glargine to the benefit of all diabetes patients requiring insulin.

Highlights

There is an estimated 451–463 million people worldwide with diabetes mellitus (Chan et al, 2021; Liu et al, 2020), with current growth rates likely to continue (Chan et al, 2021; Lin et al, 2020)
This is similar to our previous study in Nigeria as well as other African countries regarding activities concerning the purchasing of medicines during the initial months following the recent COVID-19 pandemic (Haque et al, 2021b; Kibuule et al, 2021; Sefah et al, 2021)
We will first discuss changes in the utilization of longacting insulin analogs, principally insulin glargine, among the hospitals in Bangladesh, Kenya, and Nigeria before discussing the situation seen among community pharmacies in Bangladesh and Nigeria

Summary

Introduction

There is an estimated 451–463 million people worldwide with diabetes mellitus (Chan et al, 2021; Liu et al, 2020), with current growth rates likely to continue (Chan et al, 2021; Lin et al, 2020). Low- and middle-income countries (LMICs) account for the vast majority of patients with diabetes world-wide (Chan et al, 2021; Lin et al, 2020), and this will continue These high and growing prevalence rates will have an appreciable impact on morbidity, mortality, and health related costs among LMICs (Chan et al, 2021; Lin et al, 2020; India State-Level Disease Burden Initiative Diabetes C, 2018; Bommer et al, 2018; Mutyambizi et al, 2018; Mapa-Tassou et al, 2019). As a result, estimated costs associated with the management of patients with diabetes world-wide were up to US$1.3 trillion in 2015, potentially rising to US$2.1–US$2.5 trillion by 2030, equating to over 2% of Gross Domestic Product (Bommer et al, 2018; Mapa-Tassou, 2019)

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Conclusion