Utilisation and expenditure on long-acting insulin analogues among selected middle-income countries with high patient co-payment levels: findings and implications for the future

The number of patients with diabetes and associated complications is rising across countries including patients requiring insulin to control their diabetes. Hypoglycaemia combined generally with poor control adds to the burden of diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia, including nocturnal hypoglycaemia, and enhance adherence, which can be a problem. These benefits have resulted in increased use among high and high-middle income countries, which is continuing. However, concerns in middle and lower-income countries as insulin analogues are considerably more expensive than standard insulins. Biosimilars can reduce their costs. Consequently, important to ascertain current usage and prices of analogues across middle-income countries with high patient co-payment levels to provide future direction. Overall, limited use of insulin glargine in Kenya up to 3.6% of total insulins in one leasing hospital with prices up to 3.4 fold higher than standard insulins. Overall, limited use of insulin glargine among hospitals in Northern Nigeria and in pharmacies again due to high prices. Appreciably higher use of long-acting insulin analogues in Bangladesh enhanced by low cost biosimilars with increasing competition. Increased competition enhanced by local production can lower biosimilar costs enhancing future use of insulin glargine to the benefit of all diabetes patients requiring insulin.