Designer drugs ‘cost NHS millions’
By Helen Briggs Health editor, BBC News website
Insulin injection NHS spending on insulin has been rising
Doctors have “wasted” millions on “designer” diabetes drugs when cheaper ones would have been just as effective, according to a report.
The NHS could have saved £625m over 10 years if the older types of insulin recommended in guidelines had been prescribed, claim UK researchers.
The study, published online in BMJ Open, found the NHS spent £2.73bn on insulin, mainly on “designer” forms.
A diabetes charity said patients should have a choice of what insulin to use.
Researchers at Cardiff University found NHS spending on insulin prescriptions in England, Wales, Scotland and Northern Ireland rose from £156m a year in 2000 to £359m in 2009.
Over the same period, annual NHS spending on “designer” insulin increased from £18m (12% of total insulin cost) to £305m (85% of total insulin).
Based on the assumption that all patients could have been prescribed alternative forms of insulin, the NHS could have saved itself £625m, said the Cardiff University report.
Professor Craig Currie of the Department of Primary Care and Public Health told the BBC: “The regulatory agencies have to get a grip of the way that medicines are chosen and dispensed.
“The decisions aren’t informed. The doctors aren’t listening to guidelines. The system has to change to use medicines that represent the best value for money.”
Many patients with diabetes need to inject insulin, to help their body process glucose from food.
There are several types of insulin; including insulin made in the lab to mimic natural insulin (human insulin) and newer laboratory-made human insulins, which have been tweaked to affect the speed of action or enhance certain properties (“designer” insulin, or insulin analogues).
These newer types of insulin may have some advantages for certain patients, such as reducing weight gain and reducing the risk of low blood sugar.
But most experts believe the benefits are modest, the authors said in BMJ Open.
The medicines watchdog NICE recommends that ordinary human insulins are used as a first-line treatment, with the newer “designer” human insulins reserved for exceptional circumstances.
A spokesperson for the Department of Health said: “NICE guidance recommends that human insulin is the preferred option when insulin therapy is necessary in Type 2 diabetes.
“The National Prescribing Centre advises that newer synthetic insulins have a role in treating some patients, but people with glycaemic control problems should be properly assessed for underlying causes before these newer, more expensive insulins are considered.”
Simon O’Neill, Director of Care, Information and Advocacy at Diabetes UK, said insulin analogues should be as available to all people with diabetes.
He said: “The decision of which insulin is the most appropriate for a person with diabetes should be made on an individual basis in consultation with the person with diabetes themselves.”
I’ll leave others to comment on the BBC article. The BMJ piece has a huge set of assumptions and it acknowledges this. It also a significant note on the difference in costing between type 1 and 2.
I think the thing that irritates me about this article is the use of the word “designer”. As if humalog is some fancy-pants la-de-dah thing that we diabetics use because it sparkles or smells nice or something.
‘Designer’ insulins aren’t things WE ask for, but I do think Doctors THINK they are better sometimes when they are not, and without reading the research reports on the new insulins they are prescribing.
Human insulin was tested on only 300 people for quite a short period of time before being launched onto every diabetic in the country.
This is the reviewers summing up of the research into short acting insulin analogues:
REVIEWERS’ CONCLUSIONS: Our analysis suggests only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin. Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues. Due to fears of potentially carcinogenic and proliferative effects, most studies to date have excluded patients with advanced diabetic complications. For safety purposes, we need a long-term follow-up of large numbers of patients who use short acting insulin analogues. Furthermore, we need well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.
PMID: 15106199 [PubMed – as supplied by publisher]
Did you get the idea that we were changed over cautiously? And- were you told to get your injection sites checked by your Dr for tumours? No? No, no Dr ever did or knew about this I don’t think. The cancer risk of analogues is still uncertain, and was pointed up by the Cochrane report. Which also came to the same conclusion as above – these newer insulins are not necessarily better for you.
I know that when I went onto human insulin, I got much better control. (In this test study of 1, it was 100% success )
I also know that I always had my insulin sites checked by a nurse at my clinic appointments – what they were checking for I suspect was hyperlipertrophy, but perhaps you shouldn’t second guess things.
And I wouldn’t want to go back to the older human insulins, at definitely not the porcine/bovine insulins. But in the same way, I wouldn’t want anyone to feel they were being forced onto an insulin that didnt suit them (or their beliefs).
Choice is key. And that is important – some (maybe alot of) doctors dont provide the information to allow those who want it to make their own informed choice or the possibility of choice itself.
Oh, no second guessing, I know loads of Drs and asked Drs after I read these conclusions and none had heard of the guidelines.
But yes, I know lots of people are better on quicker-acting insulin, but i view all analogues with suspicion. And i do think we should be given all the information – the problem is GPs in particular do not know all the information, they just prescribe the latest thing as if it’s better without even stopping to think about it.
I started getting much worse and more frequent hypos with ‘human’ insulin. Then lost my warning symptoms.
Exactly – your choice (through necessity) is for animal insulin, and mine (through a much lesser but still valid need) is for human analogue. And part of that (not the need itself, but the understanding of the need) is because we are well informed about the whole system – but I do suspect that we (that is, those diabetics who are still following this, as opposed to the majority of diabetics, particularly T2s, who just get whatever treatment is handed out by their GP) are in the minority – and probably know more about it than many GPs, who are, by their job descriptions, generalists, not specialists, who will just do whatever the latest NICE or PCT or whatever guidelines suggest. Which is where hospital clinics and consultants/specialists/DSNs come in, but again, the (I suspect) vast majority don’t even know they exist, let alone are referred to them – after all, its expensive…and as the original post says, we are a drain on society…This is turning into a rant I think so I’ll stop there…
Lol, I think we are in agreement. I asked my Consultant (not recent ones) if they had heard about the info about checking injection sites and they had not, ditto nurses.
I used to have a lot to do with IDDT, their slogan, voice for choice, was my idea. I do believe we should all have choice. But I also believe that even if we get it, we have not, and will never get, the information which would make it a REAL choice.