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Cost of insulin analogues – NHS has wasted £625 million on analogue insulin in the past 10 years
Research published online in BMJ Open has shown that the NHS has spent an extra £625 million over the past 10 years on analogue insulins when the recommended human insulin alternatives, which are considerably cheaper, would probably have been just as effective. During this period, insulin analogues were 47% more expensive than human insulin. The authors base their findings on an analysis from the four UK prescription pricing agencies for the years 2000 to 2009. [Costs were adjusted for inflation and reported at 2010 prices.]
Over the 10 years:
- The NHS spent a total of £2,732 million on insulin with the annual cost rising by 130%, from £156 million to £359 million.
- Prescriptions for analogue insulin accounted for £1,629m [59% of the total]. Human insulin accounted for £1,056m [39% of the total] and animal insulin accounted for £47.2m [2% of the total].
- The annual cost of analogue insulin rose from £18.2 million [12% of the total] to £305 million [85% of the total].
- The cost of human insulin fell from £131 million [84% of the total] to £51 million [14% of the total].
The authors of this study point out:
- If prescribing guidelines recommending human insulin as first choice treatment for Type 2 diabetes had been followed, there would have been considerable financial savings.
- If all patients prescribed insulin analogues had been prescribed human insulin instead, the NHS could have saved itself £625 million [though to be more accurate, it is tax payers’ money that would have been saved].
- If even half of these patients had been changed to human insulin, that still would have been a saving of £300 million.
- Insulin analogues were developed to mimic the action of insulin made by the body but according to the authors, it is not clear if the benefits are sufficient to justify the additional costs as there has been no observable clinical benefit.
Study author, Professor Craig Currie from Cardiff University told Pulse [22.09.22]: ‘While it has been shown that insulin analogues are associated with reduced weight gain, less hypoglycaemia (particularly nocturnal), improved lowering of postprandial glucose and improved dosing schedules, most commentators agree that these benefits are modest in comparison to human insulin. The cost effectiveness of analogues insulin depended on the type of diabetes, the individual patient and the type of synthetic insulin used. For example, rapid-acting insulin analogues in patients with type 1 diabetes are likely to be a cost-effective use of finite healthcare resources.’
To view the paper in full click here:
- There are over 2.5 million people with diabetes in the UK and 90% have Type 2 diabetes, some of whom take insulin and 10% have Type 1 diabetes.
- Both human and analogue insulins are synthetic and made in a laboratory.
- Pork and beef insulins are natural insulins derived from the pancreases of pigs and cattle. They were the only available insulins until human insulin was marketed in 1982.
The NICE guidelines for treatment of Type 1 diabetes recommend that the experiences and preferences of the insulin user should be taken into account and the type of insulin prescribed should be the one that allows people optimal wellbeing.
NICE guidelines for Type 2 diabetes recommend that human insulin is prescribed as first line treatment. Alternative insulin analogue treatments (such as insulin detemir or insulin glargine) should only be given in particular circumstances. These are:
- if they reduce the number of injections required in a person who needs assistance from a healthcare professional to inject insulin
- if episodes of symptomatic hypoglycaemia restrict the person’s lifestyle and the person would otherwise need twice-daily NPH insulin injections in combination with oral glucose-lowering drugs
- or if the person cannot use the device to inject NPH insulin.
The advice to GPs
Dr Brian Karet, a GPSI in diabetes in Bradford, said the benefits of analogue insulin were ‘marginal’ and so GPs should consider switching patients to human insulin in light of these findings. He said: ‘I think it is essential that we do this. It will certainly save a significant amount. Commissioning groups are already considering costs and benefits, and this is a very obvious one.’ [Pulse, Sept 22nd 2011]
Our first reaction is that at last there has been a dawning of the true facts about insulin analogues! IDDT has written many times over the last few years about the pharmaceutical industry’s marketing techniques when they introduce their latest insulin products. All too often it is marketing rather than evidence of benefit which accounts for the increasing use of new insulins.
We saw this first with the introduction of human insulin in 1982. For the majority, there was a lack of evidence of benefit of human insulin over animal insulin [Cochrane Systematic Review, 2005]. Sales of human insulin rapidly increased with greater expense as they were significantly more expensive than animal insulin.
In 2008, we wrote about this similar trend with insulin analogues – the marketing kicked in. We reported the findings of two reviews carried out in Germany by the Institute for Quality and Efficiency in Healthcare [IQWiG, 2008] which not only questioned the use of insulin analogues but recommended that they were not funded in Germany unless the price was the same as human insulin.
In 2010, as a result of the Channel 4 programme, we again highlighted all these points and questioned why prescribers and PCTS have not taken notice of the NICE Guidelines on insulin.
This is now in the public domain and receiving considerable publicity. IDDT suggests there are other points to consider.
- Novo Nordisk has already announced their intention to globally discontinue human insulins. Indeed they have already started with the withdrawal of Mixtard 30 at the end of 2010, used by 90,000 people. In the light of the BMJ study, is Novo Nordisk going to revise its plans?
- Rapid-acting analogues are more aggressive and of shorter duration than short-acting human insulins. If people who need a regime of short and long-acting insulin are prescribed analogues, they usually will have pre-meal injections and therefore have to test their blood glucose more often. This is an additional extra cost compared to using twice daily human insulin.
- Perhaps most important of all, the long-term safety of analogue insulins has not been established and research continues. So they have been shown not to be beneficial for the majority, considerably more expensive and their long-term safety is not yet proven.