The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Brian Godman*, Mainul Haque, Trudy Leong, Eleonora Allocati, Santosh Kumar, Salequl Islam, Jaykaran Charan, Farhana Akter, Amanj Kurdi, Carlos Vassalo, Muhammed Abu Bakar, Sagir Abdur Rahim, Nusrat Sultana, Farzana Deeba, M. A.Halim Khan, A. B.M.Muksudul Alam, Iffat Jahan, Zubair Mahmood Kamal, Humaira Hasin, Munzur-E-MurshidShamsun Nahar, Monami Haque, Siddhartha Dutta, Jha Pallavi Abhayanand, Rimple Jeet Kaur, Godfrey Mutashambara Rwegerera, Renata Cristina Rezende Macedo do Nascimento, Isabella Piassi Dias Godói, Mohammed Irfan, Adefolarin A. Amu, Patrick Matowa, Joseph Acolatse, Robert Incoom, Israel Abebrese Sefah, Jitendra Acharya, Sylvia Opanga, Lisper Wangeci Njeri, David Kimonge, Hye Young Kwon, Seung Jin Bae, Karen Koh Pek Khuan, Abdullahi Rabiu Abubakar, Ibrahim Haruna Sani, Tanveer Ahmed Khan, Shahzad Hussain, Zikria Saleem, Oliver Ombeva Malande, Thereza Piloya-Were, Rosana Gambogi, Carla Hernandez Ortiz, Luke Alutuli, Aubrey Chichonyi Kalungia, Iris Hoxha, Vanda Marković-Peković, Biljana Tubic, Guenka Petrova, Konstantin Tachkov, Ott Laius, András Harsanyi, András Inotai, Arianit Jakupi, Svens Henkuzens, Kristina Garuoliene, Jolanta Gulbinovič, Magdalene Wladysiuk, Jakub Rutkowski, Ileana Mardare, Jurij Fürst, Stuart McTaggart, Sean MacBride-Stewart, Caridad Pontes, Corinne Zara, Eunice Twumwaa Tagoe, Rita Banzi, Janney Wale, Mihajlo Jakovljevic

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Original languageEnglish
Article number671961
JournalFrontiers in Public Health
Publication statusPublished - 24 Jun 2021


  • Africa
  • Europe
  • biosimilars
  • cross-national study
  • drug utilisation
  • health policy
  • insulin glargine
  • prices


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