Insulin glargine in a Brazilian state: should the government disinvest? an assessment based on a systematic review

Ana Luísa Caires de Souza, Francisco de Assis Acurcio, Augusto Afonso Guerra Júnior, Renata Cristina Rezende Macedo Do Nascimento, Brian Godman, Leonardo Maurício Diniz

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Introduction and Objective: The costs of the insulin analogue (insulin glargine) have been growing appreciably in the State of Minas Gerais in Brazil, averaging 291 % per year in recent years. This growth has been driven by an increasing number of successful law suits and a 536 % price difference between insulin glargine and neutral protamine Hagedorn (NPH) insulin. One potential way to address this is to undertake a systematic review assessing the efficacy and safety of insulin glargine analogue compared with NPH insulin in patients with type 1 diabetes mellitus (T1DM), and, as a result, provide published data to support future recommended activities by the State of Minas Gerais. These could include maintaining it on the list of the Public Health System (SUS) provided there is a price reduction. Alternatively, the review could provide potential arguments to defend against future law suits should the authorities decide to delist insulin glargine. Methods: A systematic review of published studies researching the effectiveness of insulin glargine in patients with T1DM between January 1970 and July 2009 in MEDLINE (PubMed), the Latin American and Caribbean Centre on Health Sciences Information, the Cochrane Controlled Trials Databases and the National Health Service Centre for Reviews and Dissemination. Inclusion criteria included insulin glargine on its own or combined with other insulin formulations. Only randomised controlled clinical trials were included. Initially, the titles of all studies were assessed by two independent reviewers before being potentially discarded, with the quality of papers assessed using a modified Jadad scale. The outcome measures included blood levels of glycated haemoglobin, episodes of hypoglycaemia, adverse effects and the reduction of microvascular and macrovascular end-organ complications of T1DM. Results: Out of 803 studies found in the selected databases, only eight trials met the inclusion criteria. Most of the studies were of poor methodological quality or had a high risk of bias, with a mean score of 2.125 on the Jadad scale. No study could be classified as double-blind, and only one study documented the increased efficacy of insulin glargine in relation to both glycaemic control and hypoglycaemic episodes. Typically, there was no significant difference between insulin glargine and NPH insulins. Conclusions: This systematic review showed no therapeutic benefit of insulin glargine over other insulin formulations studied when analysing together glycaemic control and the frequency and severity of hypoglycaemia. We therefore recommend to the State Authority to delist insulin glargine or renegotiate a price reduction with the manufacturer. This systematic review provides support for this decision as well as documentation to combat potential law suits if discussions are unsatisfactory.
LanguageEnglish
Pages19-32
Number of pages14
JournalApplied Health Economics and Health Policy
Volume12
Issue number1
Early online date3 Jan 2014
DOIs
Publication statusPublished - Feb 2014

Fingerprint

State Government
Isophane Insulin
Type 1 Diabetes Mellitus
Insulin
Hypoglycemia
Information Science
Insulin Glargine
Government
Systematic review
Databases
Glycosylated Hemoglobin A
National Health Programs
Diabetes Complications
Hypoglycemic Agents
PubMed
MEDLINE
Documentation
Brazil
Randomized Controlled Trials
Public Health

Keywords

  • glucose
  • hemoglobin A1c
  • insulin detemir
  • insulin glargine
  • insulin lispro
  • isophane insulin
  • pig insulin
  • blood glucose monitoring
  • body mass
  • Brazil
  • Caucasian
  • clinical effectiveness
  • continuous infusion
  • dehydration
  • diabetic patient
  • drug efficacy
  • drug safety
  • follow up
  • glucose blood level
  • glycemic control
  • government
  • hemoglobin blood level
  • human
  • hypoglycemia
  • injection site reaction
  • insulin dependent diabetes mellitus
  • insulin infusion
  • insulin treatment
  • law suit
  • review
  • survival
  • systematic review
  • diabetes mellitus, type 1
  • drug costs
  • drug evaluation
  • humans
  • hypoglycemic agents
  • insulin, isophane
  • insulin, long-acting
  • prescription fees
  • randomized controlled trials as topic

Cite this

Caires de Souza, A. L., Acurcio, F. D. A., Guerra Júnior, A. A., Rezende Macedo Do Nascimento, R. C., Godman, B., & Diniz, L. M. (2014). Insulin glargine in a Brazilian state: should the government disinvest? an assessment based on a systematic review. Applied Health Economics and Health Policy, 12(1), 19-32. https://doi.org/10.1007/s40258-013-0073-6
Caires de Souza, Ana Luísa ; Acurcio, Francisco de Assis ; Guerra Júnior, Augusto Afonso ; Rezende Macedo Do Nascimento, Renata Cristina ; Godman, Brian ; Diniz, Leonardo Maurício. / Insulin glargine in a Brazilian state : should the government disinvest? an assessment based on a systematic review. In: Applied Health Economics and Health Policy. 2014 ; Vol. 12, No. 1. pp. 19-32.
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Insulin glargine in a Brazilian state : should the government disinvest? an assessment based on a systematic review. / Caires de Souza, Ana Luísa; Acurcio, Francisco de Assis; Guerra Júnior, Augusto Afonso ; Rezende Macedo Do Nascimento, Renata Cristina; Godman, Brian; Diniz, Leonardo Maurício.

In: Applied Health Economics and Health Policy, Vol. 12, No. 1, 02.2014, p. 19-32.

Research output: Contribution to journalArticle

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T1 - Insulin glargine in a Brazilian state

T2 - Applied Health Economics and Health Policy

AU - Caires de Souza, Ana Luísa

AU - Acurcio, Francisco de Assis

AU - Guerra Júnior, Augusto Afonso

AU - Rezende Macedo Do Nascimento, Renata Cristina

AU - Godman, Brian

AU - Diniz, Leonardo Maurício

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