Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

Abstract

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.

Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

“…Whilst most people with diabetes have Type 2 diabetes (T2DM), an appreciable number of patients have Type 1 diabetes (T1DM) (Godman et al, 2020a;Godman et al, 2021c). In addition, some patients with T2DM, especially in low-and middle-income countries (LMICs), will require insulin to control their diabetes (Baruah et al, 2017;Venkataraman et al, 2020;Godman et al, 2021c).…”

“…Whilst most people with diabetes have Type 2 diabetes (T2DM), an appreciable number of patients have Type 1 diabetes (T1DM) (Godman et al, 2020a;Godman et al, 2021c). In addition, some patients with T2DM, especially in low-and middle-income countries (LMICs), will require insulin to control their diabetes (Baruah et al, 2017;Venkataraman et al, 2020;Godman et al, 2021c). Overall, it was estimated in 2019 that over 1.1 million adolescents worldwide had T1DM, including over 600,000 children under 15 years of age (Patterson et al, 2019), with an average increase in incidence rates of 3-4% per year (Tuomilehto et al, 2020).…”

“…This is because there are concerns with late diagnosis and treatment of T1DM among children especially in among African countries as well as other LMICs, which results in avoidable high mortality rates from diabetic ketoacidosis, severe hypoglycaemia, infection and eventually microvascular complications (Godman et al, 2020b;Godman et al, 2021b) adding to the global burden of diabetes. Such concerns are enhanced among LMICs where there can be high co-payments for medicines including those to treat patients with diabetes (Haque et al, 2021a;Godman et al, 2021b;Haque et al, 2021b;Godman et al, 2021c) alongside high costs for monitoring HbA1c levels negatively impacting on care (Godman et al, 2020b). As a result, access programmes and support from donor organisations are often needed among LMICs, especially African countries, to enhance the affordability of even basic insulins, as well as monitoring of HbA1c levels, among patients, and their families along with measures to enhance earlier diagnosis (Shannon et al, 2019;Godman et al, 2020b;Godman et al, 2021b;Haque et al, 2021b).…”

“…Whilst there have been concerns over their additional costs versus standard insulins such as NPH insulins, and whether this represents value (Caires de Souza et al, 2014;Almeida et al, 2018;Ewen et al, 2019;Hemmingsen et al, 2021), recent published studies, including systematic reviews, have shown that their higher acquisition costs can be offset by savings from averted costs associated with hypoglycaemia and other complications (Jendle et al, 2020;Lee et al, 2020;Shafie and Ng, 2020;Tricco et al, 2021) generating medium to long-term savings. As a result, long-acting insulin analogues are now the most widely prescribed insulins among high-income and high middle-income countries, with sales growing in other countries including Central and Eastern European (CEE) countries as well as Bangladesh and India (Silver et al, 2018;Ewen et al, 2019;Godman et al, 2021a;Haque et al, 2021a;Godman et al, 2021c;Godman et al, 2021d). This is welcomed as there have been concerns in CEE countries regarding the availability and funding of biological medicines to treat patients with rheumatoid arthritis, psoriasis, and inflammatory bowel disease (Putrik et al, 2014;Kostic et al, 2017;Baumgart et al, 2019).…”

“…This includes many African and South American countries (Godman et al, 2021a;Godman et al, 2021b). However, increased local production of insulins, building on examples in other LMICs as well as concerns with supplies of medicines during the current COVID-19 pandemic, are potential ways forward to enhance the availability and use of insulins including long-acting insulin analogues as seen in Brazil and Malaysia (Fiotec, 2015;Ogunleye et al, 2020;Godman et al, 2021b;Godman et al, 2021c). In addition, the World Health Organisation (WHO) has recently launched a pre-qualification scheme for insulins to increase competition and help lower prices (WHO, 2019).…”