The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Abstract

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.

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

“…Explore the potential for joint pan-African collaboration and research into key research activities surrounding the education of medical and pharmacy students during pandemics given the complexities of managing patients in Africa, especially those with joint infectious and non-infectious diseases, building on previous joint research projects [ 4 , 111 , 112 , 136 , 137 ].…”

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

“…Biosimilar insulin glargine, the first long-acting insulin analogue biosimilar, has been shown to have similar effectiveness and safety to the originator in a number of studies including those conducted in Japan (68)(69)(70)(71)(72). However, there can be concerns with the extent of price reductions versus originators in practice as seen in the United Kingdom, which may impact on future use in practice (73)(74)(75)(76). There have also been concerns generally with the effectiveness and safety of biosimilars across countries, which can reduce their use in the absence of demand-side measures encouraging their use (66,77,78).…”

Availability and accessibility of monoclonal antibodies in Bosnia and Herzegovina: Findings and implications

“…10,17,20 This builds on examples in other European countries where there have been considerable use of biosimilars and corresponding savings following multiple demand-side measures 10,18,43 as well as a number of countries with biosimilars of insulin glargine. 27,39 However, physicians and health authorities need to instigate policies to enhance the use of biosimilars in B&H building on successful experiences in other countries. 18,44 These include educational policies to address concerns and lack of trust with biosimilars given the impact of the nocebo effect in this area, 44,45 alongside prescribing targets and restrictions for more expensive originators.…”

“…40 In this situation, we will use DDDs to document utilisation patterns, similar to previous studies, 22 and compare the findings with other countries. 27,39,40 In accordance with local legislation neither approval from an ethics committee nor informed consent is required as this study did not deal directly with patients.…”