Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Zargar, Abdul Hamid; Kalra, Sanjay; K M, Prasanna Kumar; Murthy, Sreenivasa; Negalur, Vijay; Rajput, Rajesh; Rastogi, Ashu; Saboo, Banshi; Sharma, Surendra Kumar; Sahay, Rakesh; Aravind, S.R.; Shaikh, Shehla; Tiwaskar, Mangesh; Ingole, Shahu; Kamble, Sanjay
• Is Part Of: Diabetes & metabolic syndrome. Volume 16:Issue 8(2022)
• Publication Date: 2022-08
• Subjects: Biosimilar -- Compliance -- Diabetes mellitus -- Insulin -- Insulin analogues -- Cost of therapy; Diabetes -- Periodicals; Metabolism -- Disorders -- Periodicals; Diabetes Mellitus -- Periodicals; Metabolic Diseases -- Periodicals; Diabète -- Périodiques; Métabolisme, Troubles du -- Périodiques; Endocrinologie -- Périodiques; Diabète -- Physiopathologie -- Périodiques; Diabetes; Metabolism -- Disorders; Electronic journals; Periodicals; 616.462
• DOI: 10.1016/j.dsx.2022.102528
• Languages: English
• ISSNs: 1871-4021

Abstract

Abstract: Background and aims: The rapid increase in burden of type 2 diabetes mellitus (T2DM), poses a huge medico-economic challenge, especially when the cost of care is funded by out-of-pocket expenses. The aim of this review is to highlight various issues associated with rising cost of insulin, prevalence of cost-related insulin underuse, insulin related cost-saving behaviors, and viable solutions for the benefit of patients with T2DM receiving insulin. Methods: Electronic databases (PubMed and Google Scholar) from 2000 to 2020 were searched using the key terms uncontrolled diabetes mellitus, insulin therapy, glycemic control, direct cost, indirect cost, out-of-pocket expenses, cost-related insulin underuse, cost-saving behaviors, and biosimilar insulin in developed countries and India. Results: In majority of the patients with T2DM on monotherapy, addition of another oral antidiabetic agent is required. Despite these measures, the target glycemic goals are not achieved in majority of the patients resulting in various complications. These complications can be prevented and target glycemic goals can be achieved with early initiation of insulin therapy. However, rising cost is a major deterrent to the lifelong use of insulin. This results in non-compliance and further deterioration of glycemic control. Recently, biosimilar insulins have revolutionized the management of T2DM and look promising from the economic point of view. Conclusions: Biosimilar insulins are likely to further enhance the compliance of patients and should be used whenever feasible in patients with DM. However, the patient, along with prescriber should be allowed to make shared, informed decisions regarding the insulin they wish to use. Highlights: The rise in burden of DM has led to an exponential increase in health care cost. The ever-increasing cost of insulin results in various cost-saving behaviors and non-compliance. An entangled triplet of cost, non-compliance, and poor glycemic control leads to further rise in cost of managing the DM. The introduction of biosimilar insulin has enabled wider access of insulin with a reduced price (20–40%). A patient-centered approach involving the patient, prescriber, and payer (if relevant) should be practiced.