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 The advent of a newer, more expensive form of insulin may be behind
both trends, researchers say, but the added cost may not be
worthwhile for all patients.
“I was surprised to see that insulin use among patients with type 2
diabetes went up over time,” said one of the study’s authors, Dr.
Kasia J. Lipska from the Department of Internal Medicine at Yale
School of Medicine in New Haven, Connecticut.
More glucose-lowering drugs have become available in recent years,
which might have led to a delay in people starting on insulin or
less insulin use generally, she said, but that was not the case
according to the new findings.
The median cost for one insulin prescription rose from $19 to $36
between 2000 and 2010, the authors report in a research letter
published on Tuesday in JAMA.
Insulin analogs were nearly universally adopted over the decade for
treating type 2 diabetes, and may explain why costs went up, Lipska
told Reuters Health by email.
Insulin analogs are a molecularly altered form of the hormone,
different from synthetic human or animal insulin. Analogs may have
more flexible dosing and be more convenient than human or animal
insulin, but are also more expensive, the authors write.
“The data with regards to the benefits of insulin analogs over human
synthetic insulin is not very convincing in type 2 diabetes patients
– and they cost more,” Lipska said. “Therefore, the dramatic shift
to the more expensive insulin options is surprising.”
She and her coauthors used an existing private insurance claims
database, which by 2010 included more than 60,000 adults who were
dispensed insulin of at least one type. The average patient in the
database was 61 years old, white and from the U.S. South or Midwest.
In the year 2000, 96% of adults who used insulin used human
synthetic insulin, which dropped to less than 15% in 2010. For
insulin analogs, 19%t of people filled a prescription in 2000,
compared to more than 90% in 2010.
It’s important to ask whether the insulin analogs are worth the
increased cost, Lipska said.
“For some patients, they are,” she said. “For all patients, probably
not.”
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Analogs were adopted so quickly, despite not having many more
advantages or disadvantages than existing forms of insulin, that
marketing probably came into play, she said.
Dr. Geoff Gill, a diabetologist at the University of Liverpool in
the UK, was not a part of the new study but works closely with two
of the coauthors at the International Insulin Foundation, a small
non-governmental organization and charity dedicated to the
affordable provision of insulin to all who need it worldwide.
He told Reuters Health the added cost is a particular problem in the
developing world.
“One obstacle is that resource-limited countries are often not
buying the most economic insulins - and the ‘analogue debate’
(particularly in type 2 diabetes) comes in here,” Gill wrote in an
email.
Most of their work has been in Africa, where he believes the message
is getting through, but it is not an easy task, he said.
In 2000, about 10% of people with type 2 diabetes filled a
prescription for insulin, which had risen to 15% by 2010. It’s hard
to say whether that increase is a good or bad thing, Lipska said.
“Patients should be informed – and empowered – to participate in
treatment decisions,” she said. “They should talk to their
clinicians about the tradeoffs of using insulin analogs versus human
synthetic insulin.”
SOURCE: http://bit.ly/1q1yyjO
JAMA 2014.
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