Availability and use of long-acting insulin analogues including their biosimilars across Africa; findings and implications

Godman, Brian and Leong, Trudy and Abubakar, Abdullahi Rabiu and Kurdi, Amanj and Kalemeera, Francis and Rwegerera, Godfrey Mutashambara and Patrick, Okwen and Lum Niba, Loveline and Ibrahim, Kamilou and Amu, Adefolarin A and Matowa, Patrick and Acolatse, Joseph and Incoom, Robert and Sefah, Israel and Opanga, Sylvia and Njeri, Lisper Wangeci and Kimonge, David and Oluka, Margaret and Chikowe, Ibrahim and Khuluza, Felix and Phiri, Henry and Kibuule, Dan and Hango, Ester and Sani, Ibrahim Haruna and Malande, Oliver Ombeva and Piloya-Were, Thereza and Alutuli, Luke and Kalungia, Aubrey Chichonyi and Chaibva, Blessmore Vimbai and Zaranyika, Trust and Haque, Mainul and Allocati, Eleonora and Campbell, Stephen and Adwubi, Eunice Twumwaa and Ogunleye, Olayinka (2021) Availability and use of long-acting insulin analogues including their biosimilars across Africa; findings and implications. Internal Medicine, 11 (4). 100343. ISSN 0918-2918 (https://www.longdom.org/abstract/availability-and-...)

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Abstract

Background: Prevalence rates of diabetes mellitus are growing across Africa with an appreciable number likely to be on insulin to manage their condition. This has significant implications on future morbidity and mortality exacerbated by high complication rates. Complication rates in patients requiring insulins are enhanced by hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve patient compliance. However, they are typically appreciably more expensive than human and other insulins in Africa, and continuing controversies surrounding their benefits limits their listing on national essential medicine lists (EMLs). Biosimilars can reduce the prices long-acting insulin analogues. This needs assessing. Methods: Mixed methods approach including documentation of insulin utilisation patterns and prices among a range of African countries. In addition, input from senior level government, academic, and healthcare professionals from across Africa on the current situation with long-acting insulin analogues as well as potential changes needed to enhance future funding of long-acting analogue biosimilars. Results: There is variable listing of long-acting insulin analogues on national EMLs across Africa due to their high prices and issues of affordability. Even when listed, utilisation of long-acting insulin analogues is limited by similar issues including affordability. Appreciably lowering the prices of long-acting insulin analogues via biosimilars should enhance future listing on EMLs and use accompanied by educational and other initiatives. However, this will require increased competition to lower prices. Conclusion: There are concerns with value and funding of long-acting insulin analogues across Africa including biosimilars. A number of activities have been identified to improve future funding and listing on EMLs.

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