Benefits of insulin analogs may be overrated
MedWire News: The benefits of using insulin analogs rather than human insulin are not necessarily sufficient to outweigh their increased cost to the National Health Service (NHS), say UK researchers.
"While it has been shown that insulin analogs are associated with reduced weight gain, less hypoglycemia, improved lowering of postprandial glucose and improved dosing schedules, most commentators agree that these benefits are modest in comparison to human insulin," they say.
The UK National Institute for Health and Clinical Excellence (NICE) recommends the use of human neutral protamine Hagedorn insulin (NPH) as first-line therapy and use of the analog insulin glargine only in specific circumstances.
Accordingly, Craig Currie (Cardiff University) and colleagues analyzed open data from the four prescription pricing agencies for England, Northern Ireland, Scotland, and Wales and investigated the pattern of insulin prescriptions in the UK over recent years.
The authors found that between 2000 and 2009, annual NHS spending on analog insulin increased from £18/(US)$28/€21 million (12% of total insulin cost) to £305/$473/€351 million (85% of total insulin cost), while annual NHS spending on human insulin fell from £130/$202/€150 million (84%) to £51/$79/€59 million (14%).
"If all dispensations for analog insulin between 2000 and 2009 had used the equivalent human insulin, we estimate the NHS would have saved £625 million," they say.
However, NICE has determined that insulin glargine borders on being cost effective at current willingness to pay thresholds in patients with Type 1 diabetes but that it is not cost effective in Type 2 diabetes, note the researchers.
Furthermore: "The longest trial comparing insulin glargine with insulin isophane concluded that there was a similar progression to retinopathy with the two agents but less improvement in glycated hemoglobin levels for the more expensive product, insulin glargine," Currie et al add.
The researchers suggest that the increase in the use of analog insulin is likely to be due in part to successful marketing as well as them being made available in new devices that may be more appealing to patients and easier to use than the devices used to administer human insulin.
"The fact that 40% of analog insulin was prescribed as a prefilled pen device compared with just 18% of human insulin supports this suggestion," they say.
The team concludes: "At the macroeconomic level, we know that the rise of insulin analogs has had a substantial financial impact on the NHS, yet over the same period there has been no observable clinical benefit to justify that investment.
"It is likely that there was and is considerable scope for financial savings. Most worryingly, the clinical role and safety of insulin for use in people with type 2 diabetes is being questioned."
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By Sally Robertson