Revisiting Prices and Barriers for Treating Type II Diabetes With Biosimilar Insulin in Low and Lower-Middle Income Economies (LMICs) in Africa

OBJECTIVES: Type II diabetes is a global challenge with growing incidence worldwide. Biologic medications (Insulin) and chemically derived drugs (e.g., biguanides) help manage this disease. Biosimilars and generics are less costly copies with similar benefits, particularly needed in LMICs, however adoption is challenging.

We estimate potential price reductions in diabetes treatment with Insulin biosimilar compared to its biologic reference in selected LMICs where data was available (Burundi, Cameroon, Chad, Congo DR, Ghana, Kenya, Nigeria). Barriers to biosimilars’ adoption are then presented.

METHODS: Diabetes biosimilars are recent developments, introduced to high-income markets in 2021, while in LMICs its access is limited. To estimate potential treatment price reduction when using biosimilar Insulin in LMICs, we use the percent difference between treatment price of originator and generic biguanide (Metformin) as a proxy and apply it to the treatment price of biologic insulin (Glargine). Metformin and Insulin prices were obtained from Health Action International being adjusted to 2022 Consumer Price Index. Number of diabetic adults was obtained from International Diabetes Federation Atlas. Monthly price was estimated for treating all type II diabetes persons across selected countries. Adoption barriers were collected from a literature review.

RESULTS: More than 7 million people have type II diabetes across analyzed countries. One-month Metformin treatment price was 52% higher than its generic copy. Price per monthly treatment of all diabetic persons with Insulin Glargine was 165.4 million USD, while estimated biosimilar price could be reduced to 79.3 million USD. Prices were estimated by country, and percent differences were calculated in scenario analysis. Barriers to biosimilars’ adoption include: no country-level established regulatory framework, availability of cheaper illegal biologics, lack of trust in treatment.

CONCLUSIONS: Access to affordable biosimilars is critical to improving healthcare in LMICs. Policies aimed at leveraging potential savings and overcoming barriers to adoption can help improve access to much needed therapies.