Assessing utilisation and expenditure on long-acting insulin analogues in Kenya; findings and implications for the future

Opanga, Sylvia and Njeri, Lisper Wangeci and Kimonge, David and Godman, Brian and Oluka, Margaret (2021) Assessing utilisation and expenditure on long-acting insulin analogues in Kenya; findings and implications for the future. Scholars Academic Journal of Pharmacy, 10 (4). pp. 63-70. ISSN 2347-9531

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    Prevalence rates for patients with diabetes mellitus are rising across countries including sub-Saharan African countries, which will continue. As a result, there are an increasing number of patients with insulin-dependent diabetes across sub-Saharan Africa including Kenya. Growing prevalence rates are increasing the costs of treating patients with diabetes enhanced by associated complications. These include both microvascular and macrovascular complications, with hypoglycaemia and generally poor control of diabetes contributing to the burden. Long-acting insulin analogues were developed to reduce rates of hypoglycaemia associated with insulin usage, including nocturnal hypoglycaemia, and improve adherence through improving patient convenience. As a result, they are now included in the Kenyan Essential Medicines List. However, long-acting insulin analogues are typically considerably more expensive than standard insulins limiting their use in practice, especially in countries such as Kenya with concerns with affordability even for standard insulins such as Mixtard®. Consequently, a need to ascertain current utilisation and expenditure patterns for the different insulins including long-acting insulin analogues across Kenya starting with leading referral hospitals. Research in Kenyatta National Hospital (KNH) showed growing use of insulin glargine reaching up to 3.4 to 3.6% of total insulin utilisation in 2019 and 2020. However, prescribing was limited by considerably higher prices (3.4 fold higher) than standard insulins on a defined daily dose basis. Considerably higher prices resulted in no utilisation of long-acting insulin analogues in another leading referral hospital in Kenya. Overall, appreciably lowering the prices of long-acting insulin analogues through instigating local production and other activities should increase their use benefiting patients and the healthcare system in Kenya and wider. These are considerations for the future.