Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

Godman, Brian and Haque, Mainul and Kumar, Santosh and Islam, Salequl and Charan, Jaykaran and Akter, Farhana and Kurdi, Amanj and Allocati, Eleonora and Bakar, Muhammed Abu and Rahim, Sagir Abdur and Sultana, Nusrat and Deeba, Farzana and Khan, MA Halim and Alam, ABM Muksudul and Jahan, Iffat and Kamal, Zubair Mahmood and Hasin, Humaira and Murshid, Munzur-E and Nahar, Shamsun and Haque, Monami and Dutta, Siddhartha and Abhayanand, Jha Pallavi and Kaur, Rimple Jeet and Acharya, Jitendra and Sugahara, Takuma and Kwon, Hye-Young and Bae, SeungJin and Khuan, Karen Koh Pek and Khan, Tanveer Ahmed and Hussain, Shahzad and Saleem, Zikria and Pisana, Alice and Wale, Janney and Jakovljevi, Mihajlo (2021) Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future. Current Medical Research and Opinion, 37 (9). pp. 1529-1545. ISSN 0300-7995 (

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Introduction: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies. Methodology: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries. Results: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries. Conclusions: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.