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Affordable Diabetes Drugs: A Global Perspective
Availability and Affordability of Essential Diabetes Medicines
Metformin and Insulin Accessibility
Metformin, a widely used first-line treatment for type 2 diabetes, is generally available across various income regions. In high-income countries, metformin is available in 100% of pharmacies, while its availability drops to 64.7% in low-income countries, excluding India, where it is also fully available1. Insulin, another essential diabetes medication, shows a more significant disparity. It is available in 93.8% of pharmacies in high-income countries but only in 10.3% of pharmacies in low-income countries1. This disparity highlights the challenges faced by low-income regions in accessing essential diabetes medications.
Affordability Challenges
The affordability of diabetes medications is a significant issue, particularly in low-income countries. In high-income countries, only 0.7% of households cannot afford metformin, compared to 26.9% in low-income countries. For insulin, the figures are 2.8% and 63.0%, respectively1. This stark contrast underscores the economic barriers that prevent effective diabetes management in poorer regions.
Cost-Effectiveness of Newer Antidiabetic Drugs
Price Targets for Novel Agents
Newer antidiabetic drugs, such as SGLT2 inhibitors and GLP-1 receptor agonists, have shown promise in reducing diabetes-related complications. However, their high costs pose a barrier to widespread use in low- and middle-income countries (LMICs). To achieve cost-effectiveness, SGLT2 inhibitors would need to be priced at $224 per person per year, while GLP-1 receptor agonists would need to be priced at $208 per person per year2. These price targets are essential for negotiations to include these drugs in national formularies and improve access for patients in LMICs.
Economic Impact of Generic Drugs
Generic drugs offer a more affordable alternative to branded medications. For instance, the lowest-priced generic (LPG) of metformin 500 mg has a high availability rate of over 80% in surveyed countries3. However, the availability of generic insulin is significantly lower, with a total mean availability of only 36.21%3. This indicates a need for increased production and distribution of generic insulin to improve affordability and access.
Price Variation and Its Impact
Cost Variation in India
In India, the cost of diabetes medications varies significantly between different brands. For example, the price of metformin 500 mg sustained release can vary by up to 3668% between brands6. Such variations can financially burden patients and reduce compliance with treatment regimens. Therefore, it is crucial to include more antidiabetic drugs under price control policies to ensure affordable and effective treatment options are available to all6.
Global Trends in Antidiabetic Drug Prices
The cost of antidiabetic medications, particularly insulin, has increased dramatically over the years. In the U.S., expenditures for antihyperglycemic medications rose from $10 billion in 2002 to $22 billion in 2012, driven primarily by the increased cost of insulin9. This trend highlights the need for policy interventions to control medication prices and ensure that diabetes treatment remains accessible.
Conclusion
The availability and affordability of diabetes medications vary significantly across different income regions. While metformin is generally accessible, insulin availability remains a challenge in low-income countries. Newer antidiabetic drugs offer promising benefits but are often too expensive for widespread use in LMICs. Generic drugs provide a more affordable alternative, but significant price variations exist, particularly in countries like India. Addressing these disparities through policy interventions and price control measures is essential to improve global access to diabetes treatment.
Sources and full results
Most relevant research papers on this topic
Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study.
Availability and affordability of essential diabetes medicines vary across high-income, middle-income, and low-income countries, with significant differences in medicine use.
Observational Study
Highly CitedExpanding access to newer medicines for people with type 2 diabetes in low-income and middle-income countries: a cost-effectiveness and price target analysis.
Newer antidiabetic drugs for type 2 diabetes in low-income and middle-income countries can reduce complications and costs, but require reduced prices to achieve cost-effectiveness and net cost-savings.
Observational StudyThe Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries
Essential diabetes medicines are more affordable in high-income countries than low-income countries, with most low-priced generics being affordable to the lowest-paid unskilled worker.
Observational StudyLow-cost generics a mixed blessing for diabetes treatment
Big-box retailers' low-cost generic drug programs have boosted the cost of branded diabetes medications by up to 113% since 2008.
Metabolic Action of Metformin
Metformin effectively suppresses hepatic glucose production, improves insulin sensitivity, and alters gut microbiota composition, maintaining intestinal barrier integrity, and reducing inflammation in type 2 diabetes patients.
Cost variation analysis of commonly prescribed anti-diabetic drugs available in Indian market: a pharmaco-economic study
Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary lifestyle, the incidence of DM is increasing. The chronic nature of DM causes significant personal suffering and economic difficulty to families. The was aimed at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various pharmaceutical companies were obtained from current index of medical specialties (CIMS) website, Indian drug review (IDR) 2021 issue and National pharmaceutical pricing authority-pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, metformin 500 mg sustained release showed highest price variation (3668%). Minimum cost variation was found with glipizide 2.5 mg (65%). Amongst the fixed dose combinations, highest cost variation was seen with glimepiride 2 mg+metformin 1000 mg (2703%) while minimum cost variation was found with repaglinide 1 mg+voglibose 0.3 mg (29%).Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all.Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands
Comparative Effectiveness of Glucose-Lowering Drugs for Type 2 Diabetes
In diabetic patients at low cardiovascular risk, no treatment differs from placebo for vascular outcomes, while specific GLP-1 RAs and SGLT-2 inhibitors improve cardiovascular outcomes in patients with increased cardiovascular risk.
Meta-Analysis
Rigorous JournalHighly CitedAnti-diabetic drugs and weight loss in patients with type 2 diabetes.
GLP1-RA and Tirzepatide are the most effective in inducing weight loss in patients with type 2 diabetes, with exenatide causing mild weight loss.
Systematic ReviewRigorous JournalHighly CitedWhy Are Diabetes Medications So Expensive and What Can Be Done to Control Their Cost?
Diabetes medications have become expensive due to factors like genetically engineered insulins, price increases, and limited negotiation opportunities.
Literature ReviewTrends in Antidiabetic Drug Discovery: FDA Approved Drugs, New Drugs in Clinical Trials and Global Sales
Nearly 60 FDA-approved antidiabetic drugs and nearly 100 in clinical trials are available for treating type 2 diabetes, with new drug combinations and personalized treatments becoming more popular.
Highly Cited