NHS overspent on modern insulins, BMJ suggests

In this austerity-minded era, the idea that a government might be overspending on drugs catches a lot of attention--especially if that spending might be unnecessary. So, expect a new study from the British Medical Journal to raise plenty of eyebrows. It suggests the U.K.'s National Health Service has spent almost $1 billion more on diabetes treatments than it should have.

Researchers looked at 10 years of spending on human insulin treatments and insulin analogs, a.k.a. modern insulins. The latter's share of insulin-drug spending rose to 85% from 12% over the period, and, partly because modern insulins are more expensive than human-insulin drugs, total insulin spending more than doubled, to £359 million from £156 million.

This might be OK if modern insulins' advantages over human insulins weren't considered "modest," at least for many patients, the researchers said. Cost-efficiency experts in Germany have questioned whether modern insulin's benefits justify the increased cost, and the U.K.'s own NICE recommends a human insulin for first-line use and an insulin analog for second-line treatment in specific circumstances, the BMJ article states.

If human insulin had been an acceptable alternative to all modern insulin use by NHS from 2000 to 2009, and the health service had restricted prescribing as such, it would have saved £625 million ($965 million), the authors figure. That's probably not realistic, they said, but NICE has suggested that 90% of Type 2 diabetes patients would do as well on human insulin. Even if only half of the modern insulin use was unnecessary, the savings still would be considerable, they noted.

"We know that the rise of insulin analogues has had a substantial financial impact on the NHS, yet over the same period there has been no observable clinical benefit to justify that investment," the authors conclude.

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