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NHS wasting tens of millions each year on expensive insulin

Testing for type-2 diabetesThe NHS is wasting tens of millions each year by using a more expensive type of insulin, despite NICE recommending a cheaper alternative.

The findings of a joint investigation by the British Medical Journal (BMJ) and Channel 4 News suggests that a drive by the drug industry to promote a new, more expensive type of insulins, known as analogue insulins, for people with type-2 diabetes has cost the NHS at least £250m extra over the past five years.

NICE advises doctors to prescribe human insulin as the treatment of choice for people with diabetes. A recent health technology assessment concluded that, in type-2 diabetes, analogue insulins weren't worth what the NHS was being charged in most cases.

The National Prescribing Centre published advice earlier this summer on 15 key areas of medicines use that local NHS organisations should scrutinise in order to save money.

This specifically drew attention to NICE's guidance about targeting of long acting insulins and the need for doctors to assess the underlying causes of poor blood sugar control before considering whether to prescribe these newer, more expensive insulins.

Analogue insulin can cost up to five times as much as conventional insulin in some markets, and now account for approximately 80 per cent of insulin use in the UK, 70 per cent in the US, and 60 per cent in Europe.

Yet the published evidence suggests that the analogues do not improve overall glucose control or safety in type-2 diabetes, although they may have marginal benefits for some patients in terms of convenience, reduced weight gain or less risk of hypoglycaemia.

Dr Amanda Adler, a consultant physician at Addebrooke's Hospital in Cambridge, said: “I would estimate that around 90 per cent of people with type-2 diabetes would probably do quite well on these human insulins compared with the long-acting insulin analogues.”

She suggested that the large market share for analogues is largely down to clever marketing.

“The new insulins have much fancier packaging - the ‘Mont Blanc of insulin devices' - than older human types,” she added.

In response to the investigation, the drug companies involved stressed the advantages of analogue insulins citing flexibility and the reduced risk of hypoglycaemia. They said the value to patients is that they offer a much better experience and that in relation to modern insulins it is important to look beyond the cost of the insulin itself.

A spokesperson for the Department of Health said: “We would expect clinicians to take into account NICE's clinical guidelines on type-2 diabetes when prescribing decisions are made.”

16 December 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.