COURTESY TIMES OF INDIA AUG 22

Newer insulin 3-5 times costlier in India, says study
Rupali.Mukherjee@timesgroup.com

Globally, one in two people who need insulin, lack access to it due to high prices and poor availability. The problem in India is availability, quality and the huge price differential between newer, second generation (rapid and long acting) insulin and older versions. The developed markets like US have also witnessed sky-rocketing insulin prices.

One of the most comprehensive studies ever done on insulin globally, published in reputed medical journal BMJ points out huge differential, saying human insulin is far more affordable than analogue insulin i.e. 1.3-1.9 (human) versus 4.6-9.2 (analogue) days’ wages. (The affordability of insulin is expressed as number of days’ wages needed by lowest paid unskilled government worker to buy 10ml insulin from private pharmacies).

Analogues (newer versions of insulin) are priced in India three to five times the price of older versions, and hence, unaffordable for a majority of Indians, experts add.

Margaret Ewen lead author of study, which compared insulin prices and availability in 13 low-income and middle-income countries (LMICs), says, “We collected patient prices in private pharmacies in Haryana and Madhya Pradesh. For human insulin, average price in the two states was $5.56 for 10ml. In other LMICs prices ranged from a low of $5.22 to a high of $43.57. For analogues, average price in India was $19.05 (per 10ml), and in other countries was $13.42 to $127.36. So prices in India were good compared to most other LMICs.”

Doctors say older insulins are as effective as analogues for most patients with type 2 diabetes. Anoop Misra, chairman Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, says: “Mostly older insulins work as well as more expensive analogue insulins, and former should be used in underprivileged people. Only if hypoglycemia (low blood sugar) occurs recurrently with older insulins, should analogues be used. For the poor who are using insulin daily, cost could be exorbitant, depending on daily dose.”

The dose may differ from 10 units to 200 units/day, and thus the expenditure will differ.

India needs to focus on availability. “Insulin must be stocked in public hospitals and clinics. We found that wasn’t always the case,” Ewen said.