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Millions “wasted” on synthetic insulins, study reveals

NHS has spent £625m too much on synthetic insulins in a decade

Louise Prime

Thursday, 22 September 2011

The NHS has wasted £625m over the past decade on prescriptions of analogue insulins, when the far cheaper human insulins would probably have been equally effective, finds a study published today in the online-only journal BMJ Open.

Researchers in Cardiff analysed data on NHS prescriptions for insulins in England, Wales, Scotland and Northern Ireland between 2000 and 2009. They then analysed costs separately, first by molecular origin, i.e. whether the insulin was analogue, human or animal, and then by individual insulin types.*

They calculated that over that decade, total NHS spend on insulin was £2732m – and the annual cost rose by 130%, from £156m in 2000 to £359m in 2009 (costs given as 2010 prices, after adjustment for inflation).

During the period studied, human insulin’s contribution to the total cost fell from 84% to 14%, while that of analogue insulin rose from 12% to 85% of the total cost.

The study’s authors argue that if even half of the patients prescribed analogue insulin had instead been prescribed human insulin, the NHS would have saved £312m over the decade – and if all patients had used human insulin instead of synthetic (which they admit is probably unrealistic), the savings would have amounted to £625m overall.

They point out that most clinical research has shown only modest benefits of analogue over human insulin, and add that NICE guidance on type 2 diabetes recommends human insulin first line, and long-acting analogues and premixed insulin only for specific circumstances.

They conclude: “We know that the rise of insulin analogues has had a substantial financial impact on the NHS, yet over the same period there has been no observable clinical benefit to justify that investment. It is likely that there was and is considerable scope for financial savings.

“Most worryingly, the clinical role and safety of insulin for use in people with type 2 diabetes is being questioned.”

*insulin soluble, insulin isophane, insulin zinc suspension mixed, insulin zinc suspension crystalline, biphasic isophane insulin, protamine zinc insulin, insulin aspart, insulin lispro, insulin detemir, insulin glargine, biphasic insulin aspart, biphasic insulin lispro and insulin glulisine

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