Patients with diabetes are constantly being offered the technological equivalent of the latest smartphone. Trouble is, many can only afford a basic handset.
The three drugmakers that dominate the world diabetes market -- Novo Nordisk A/S, Sanofi and Eli Lilly & Co. -- are introducing improved forms of insulin, the sugar-regulating hormone some patients require, with a price tag to match. But with diabetes tearing across the developing world, health officials say the focus must return to meeting basic needs.
The World Health Organization, in its first global report Wednesday on the diabetes epidemic, pointed to affordable insulin as crucial for the millions of patients who live in India, China, and other countries where few can pay for drugs. The new engineered versions of the hormone provide few demonstrated advantages over cheaper alternatives, the WHO said.
“Older, cheaper insulins may not be as good, but they may only be 10 percent worse,” said Jonathan Shaw, a diabetes consultant at the Baker IDI Heart & Diabetes Institute in Melbourne. “And if you can afford to get that extra 10 or 20 percent, that’s fine. But if you can’t, it’s a lot better than nothing.”
Three Days’ Work
Almost a century after the hormone was first extracted from calves’ pancreas, the price of engineered insulin is soaring while the basic product remains too scarce. Novo of Denmark, the market leader whose stock price has returned 60 percent in the past two years, derived less than a fifth of its 63 billion kroner ($9.6 billion) in insulin sales last year from basic human ones.
The price of insulin has risen more than three-fold over the past decade in the U.S. as engineered forms became the norm. A month of insulin treatment in Brazil would now cost the lowest-paid government worker the equivalent of about three days of pay, according to a study cited in the WHO report. That would be seven days in Nepal and almost 20 days in Malawi.
Avoid Amputation
For 23 of the world’s 48 poorest countries, Novo sells human insulin -- the cheaper kind -- for less than 19 cents per day per person. That program doesn’t include China, India, Brazil, Indonesia or the U.S., where half of adults with diabetes live, though Novo says its floor prices are similar in low-income countries.
The discounts aren’t enough. Out of about 100 million people globally who need injections of the hormone, roughly half struggle to obtain it, said David Beran, a researcher at the University of Geneva’s division of tropical and humanitarian medicine. Beran says he and colleagues have identified a list of 39 companies that may be able to supply cheaper insulin more widely. They include India’s Biocon Ltd. and Wockhardt Ltd. as well as Gan & Lee Pharmaceutical Ltd. in China.