Background: Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycemia. Long-acting insulin analogues were developed to reduce hypoglycemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive, reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues. Methods: Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-ofcharge until funds run out and all long-acting insulin analogues have to be purchased from community stores. Results: There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, now accounting for over 80% of all insulins dispensed in a minority of stores. This increase has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs than the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low-and middle-income countries struggling to fund long-acting insulin analogues for their patients. Conclusions: It was encouraging to see continued growth in the prescribing and dispensing of longacting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups.
Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers.Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders.Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries.Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production.Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.
M. (2021). Current utilisation patterns for longacting insulin analogues including biosimilars among selected Asian countries and the implications for the future. Current Medical Research and Opinion.
Background: Ovarian cancer is one of the leading causes of morbidity and mortality. Objectives: The purpose of the present study was to find out clinic-demographic and histopathological variants of ovarian cancer. Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at four largest tertiary care Hospitals in Dhaka city from January 2008 to December 2009. Clinically diagnosed and histopathologically confirmed ovarian cancer patients were included in this study. Result: Histopathological confirmed 28 patients of ovarian cancer were enrolled in this study. The mean age (±SD) was 40.6 (±12.5) years (Range 13 to 63 years). Lower abdominal lump (71.4%) was the most common symptoms. Family history (14.0%) and multiparty (53.0%) were also associated with ovarian cancer. Among 28 malignant tumors cases serious cyst adenocarcinoma (57.1%) was the most common followed by mucinous cyst adenocarcinoma (17.9%), dysgerminoma (7.1%), adenocarcinoma of ovary (7.1%), ovarian choriocarcinoma (3.6%) and endometriod adeno carcinoma (3.6%). High serum CA125 was found in 78.0% cases. Conclusion: Lower abdominal lump, multiparity and positive family history are the common clinical findings of ovarian cancer. Both serous and mucinous cyst adenocarcinoma are the common varient of ovarian cancer found in this study. [J Shaheed Suhrawardy Med Coll, 2013;5(1):3-6]
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