Rising Diabetes: Treatment Needed to Prevent Complications & Death - Research Paper

Introduction

Diabetes prevalence in both developing and developed countries is rapidly rising, mainly due to increasing cases of obesity, overweight, and lifestyle changes, including reduced physical exercise and smoking. The regular availability and affordability of treatment for this condition are critical in the prevention of complications and death. The primary treatments for type 1 and type 2 diabetes are insulin therapy and oral hypoglycemic agents, respectively. Many insulin formulations and other diabetes medications that aid in the management of metabolic abnormities in diabetic persons have been made available by most countries' health systems. However, the prices of supplies and medicines for diabetes treatment have significantly escalated over the years, making their affordability a matter of concern for patients, their families, insurers, healthcare providers, and employers.

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Insulin Prices

Studies reveal that insulin prices have significantly risen over the years despite the drug composition remaining unchanged since its discovery early in the 20th Century. For instance, the price of a vial of Humalog, an insulin formulation by Eli Lilly, has risen from $21 to $275, a 1200% increase between the years 1996 and 2019 (Roberts 1). Why would the price of a drug invented as early as 1920 keep rising over the years while the medication remains unchanged?

The chain of insulin supply from the manufacturer to the consumer contains many intermediaries or third-party entities. These include pharmacy benefits managers, the government, health plans, health insurers, and employers. The American Diabetes Association (ADA), through a working group designated with addressing the affordability of insulin, describes the chain of the drug supply, and pricing, as complex (Cefalu 1300). For instance, pharmacy benefit managers directly negotiate with pharmaceutical companies for lower drug prices to extend their discount margins. Hence, the numerous stakeholders in the manufacture, supply, distribution, and payment channels lead to multiple transactions. Consequently, no specific set point-of-sale cost for insulin formulations exists.

Government Bills

Politicians, and the Government, have appreciated that insulin and other chronic illnesses treatments are unaffordable, thereby making attempts to lower the prices. Indeed some leaders have included promises of reducing the retail cost of overpriced drugs in their campaign manifestos. An example is Donald Trump, who, since the election, managed to negotiate with major pharmaceutical companies, thereby reducing drugs' prices. However, no significant reduction has been noticed on insulin, particularly (Roberts 1).

Recently, the American Diabetes Association formally endorsed three bills drafted to legislate for lower prices of insulin and other prescription drugs. First, the Insulin Price Reduction Act aims at ensuring the reduction of the costs of all insulin products to the 2006 prices through the provision of incentives to manufacturing companies. Secondly, the Safe Step Act seeks to eliminate all barriers that affect good management practices of diabetes. The bill is also meant to prevent the delay usually encountered in treatment delivery to diabetic patients as a result of "step therapy." Through the Act, a patient may be allowed to try a drug before they can buy the medications prescribed by their physician.

Finally, the American Diabetes Association also endorsed the Chronic Condition Copay Elimination act, aimed at the removal of the requirement for copays for some services and items necessary in the treatment of chronic illnesses. Hopefully, these bills may improve the access and affordability of care to persons with diabetes (ADA 1). The federal government should be directly involved in price controls of highly essential products in the country. Elected leaders should lobby for actions and strategies that can ensure that diabetes medications are equitably accessible through measures such as price bargains with manufacturers and tax abolishment on essential medicines.

Efforts by Pharmaceutical Manufacturing Companies

Insulin manufacturing companies are introducing programs geared towards lowering the price of their product. For instance, a global pharmaceutical company, Cigna, reported through Express Scripts, the firm's pharmacy benefit manager, that they would lower their insulin cost to $25 to help approximately 700,000 diabetic patients. However, the Center for Disease Control estimates that around 30 million Americans have diabetes. Hence, Cigna is projecting to support 2.3% of the total American population that suffers from the condition. Cigna's proposal, therefore, seeks to improve the plight of a negligible fraction of the affected. Thus, 29.3 million Americans will continue paying exorbitant prices.

Sanofi, another insulin manufacturing company that dominates the world market plans to introduce the Valyou Savings Program, which they hope will help reduce the monthly insulin cost from the current $347 to $99. Similarly, Eli Lilly launched Insulin Lispro, a Humalog generic, to retail at half price. The fact that leading insulin manufacturing firms are investing in programs and initiatives that could lower the cost of the drug is an indication that the companies largely contribute to the escalating insulin prices. Some of such programs are Inside RX and Blink Health, which are reserved mainly for the low-income population of diabetic patients who earn an annual pay of less than $36,000 and who do not afford health insurance (Rosenfeld 2).

Availability of Insulin

The manufacture and supply of diabetes medication are growing over the years. However, access to these highly essential products to patients is a matter of concern due to the high prices. Cefalu et al. note that insulin prices have almost tripled between the years 2002 and 2013 (1299). According to Liu et al., there exists reduced access to reasonably priced insulin, leading to health complications and, in some instances, premature deaths (1). The scholars studied the availability and affordability of the essential treatment in China's Huabei province. The country is known as leading in terms of diabetes burden in the world. The research revealed that the availability is reasonably good in public health facilities but critically deficient in private pharmacies and other primary care facilities. Taking Huabei province as an example, the availability of insulin in public health institutions ranged between 70% and 90% while in private hospitals and pharmacies ranging averagely between 10% and 33% (Liu 4). The short supply of this essential medication leads to the overall high prices in all sectors.

Developing Countries

Low and middle-income nations also experience an inconsistent availability of essential diabetes treatments. The medications of the illness are also unaffordable in most emerging countries. Studies have reported that only approximately 30% of diabetic patients in middle and low-income countries afford to take treatments for the condition. The situation is alarming, considering further revelations that 80% of all people living with diabetes in the world are residents of developing countries (Grant 27). These nations have few diabetes management specialists and fluctuating medications' availability. The resourcing of health education is inadequate, while the implementation of the change in health-related behaviors is challenging. For instance, most patients are financially unable to make dietary adjustments necessary in the adequate management of diabetes (Grant 28).

Further study findings reveal that developing countries experience high diabetes-related mortality rates, mainly due to delayed presentation and poor access to insulin. The research reports 10% to 30% mortality associated with diabetic ketoacidosis, while hyperglycemic hyperosmolar non-ketotic coma (HONK) accounts for up to 41% death rate (Grant 28). Generic oral hypoglycemic treatments are generally reasonably affordable globally. These include glibenclamide and metformin. However, the interrupted supply of these treatments is a common occurrence in developing countries, making them usually inaccessible to patients.

A study conducted in Zambia, a developing country in Africa, revealed that the prices for most medications used in the treatment and management of diabetes are higher as compared to the international reference prices. The researchers also noted significant variations between different pharmacies. The research findings also reported that none of the medications available in the sampled outlets were affordable with reference to the absolute poverty line (Kaiser et al., 5).

The poor management of diabetes in developed countries due to the unaffordability of treatment by a majority of patients leads to a rise in the rate of both macro and microvascular complications. Consequently, the resources allocated to health in the nations' budgets are strained. An example is Tanzania, which records an annual per-person-expenditure of approximately $138 in a central hospital in Dar es Salaam. This cost is 19 times higher than the average expenditure of treating an individual per year (Grant 29). The main hospital of Tanzania's capital reported that diabetic-related complications accounted for approximately 31% of the total cost of outpatient services (Grant 29). The study recommended an improvement in a steady supply of essential medications as a primary measure that can help control the situation.

Other Consumables

While insulin and other diabetes management medicines are relatively expensive globally, the treatment of the condition requires the use of other consumables. These include insulin syringes and refrigeration, Self-monitoring of Blood Glucose (SMBG) diaries, urine and blood test strips, and clean needles, which further escalate the expense of the illness. SMBGs with test strips can cost up to an estimated expenditure of 25% of the total cost of diabetes management. Glucose meters retail at $40 and above (WebMD 1). Blood glucose test strips are also among the pricey consumables critically necessary in diabetes management. A box of 100 pieces costs $100 on average. The majority of patients do not afford to do the required regular monitoring of their glucose sugar levels due to the high cost of the consumables.

Conclusion

Diabetes supplies and medicines are unaffordable to the majority of the increasing population of patients suffering from the condition, especially in developing countries. For the reasonably affordable medicine generics, the supply in developing countries is unstable and unreliable. The price of insulin, for instance, keeps escalating over the years, despite the medication composition remaining unchanged since its invention in 1920. Besides the high cost of oral hypoglycemic agents and insulin, the management of the illness requires other consumables, including glucose meters, needles, and test strips. The unaffordability of these consumables hinders the highly recommended frequent monitoring of blood glucose. Improper management of diabetes results in either death or macro and microvascular complications, which enormously strain health systems.

Work Cited

ADA. "Bills Addressing Drug and Insulin Affordability Endorsed by the American Diabetes Association." American Diabetes Association, 15 Jan. 2020, https://www.diabetes.org/newsroom/press-releases/2020/drug-insulin-affordability. Accessed 6 April 2020.

Cefalu, William T., et al. "Insulin Access and Affordability Working Group: Conclusions and Recommendations." Diabetes Care, vol. 41, no. 6, 2018, pp. 1299-1311.

Grant, Paul. "Management of Diabetes in Resource-poor Settings." Clinical Medicine, vol. 13, no. 1, 2013, pp. 27-31.

Kaiser, Andrea, et al. "Availability, Prices, and Affordability of Es...