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The insulin dilemma in resource-limited countries. A way forward?

Gill, Geoff, Yudkin, J.S., Keen, H. and Beran, D. (2011) 'The insulin dilemma in resource-limited countries. A way forward?'. Diabetologia, Vol 54, Issue 1, pp. 19-24.

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Abstract

The International Insulin foundation (IIF) has developed and validated a needs-assessment instrument called the Rapid Assessment Protocol for Insulin Access (RAPIA) which has been used in seven countries in four continents to analyse the constraints to delivering effective
continuing care for people with diabetes. One major
contributor to the difficulties in availability of insulin is a failure to use the least costly sources and types of insulin and other effective drugs for diabetes. The purchase of insulins can consume as much as 10% of government expenditure on drugs, this being highly sensitive to the selection of newer analogue insulins as first-choice options, which cost between three and 13 times more than biosynthetic human insulin. Insulin cartridges for use with injection pens further add to costs. Similar considerations apply to most of the newer treatments for people with type 2 diabetes, which may cost up to 40 times more than metformin and sulfonylureas, still considered first-line drugs by European and US guidelines. Both biosynthetic human insulin and the first-line oral hypoglycaemic drugs are available from generic manufacturers. With the present price differentials, there is thus a growing need for countries involved in tendering for sourcing insulin to be provided with the guarantees of Good Manufacturing Practice, quality and bioequivalence, which would come from a WHO Pre-Qualification Scheme as currently exists for a variety of drugs for chronic diseases, both communicable and non-communicable. The IIF has developed a position statement on the provision and choice of diabetes treatments in resource-limited settings which should be applicable wherever consideration of resources is a component of therapeutic decision making.

Item Type: Article
Uncontrolled Keywords: Analogue insulins, Diabetes drug costs, Diabetes healthcare, Insulin regimens, Low- and middle-income countries, Needs assessment, Oral hypoglycaemic agents
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WK Endocrine System > WK 810 Diabetes mellitus
WK Endocrine System > WK 820 Insulin and its modifications
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1007/s00125-010-1897-3
Depositing User: Users 43 not found.
Date Deposited: 11 Apr 2011 11:31
Last Modified: 06 Feb 2018 13:02
URI: http://archive.lstmed.ac.uk/id/eprint/1787

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