- © 2007 Canadian Medical Association or its licensors
In a recent Analysis piece in CMAJ,1 Venkat Narayan and colleagues noted that accurate data on the costs of treating diabetes are not available for most developing countries but that extrapolation from information gathered in developed countries is possible. We examined trends in the amount and cost of medications and monitoring equipment for diabetes prescribed in England between 1991 and 2004. Data on all prescriptions dispensed in the community for diabetes treatment were obtained from the Prescription Cost Analysis system, which compiles data for England's Department of Health.
The number of prescriptions (medicines and monitoring) rose from 7 613 000 in 1991 to 24 325 640 in 2004, an increase of more than 300%. Total expenditures increased by 650%, from £68.5 million to £448.6 million (the current exchange rate is about Can$2.10 to £1). Insulins were the biggest contributor to costs (£196.8 million) followed by monitoring equipment (£131.5 million) and oral medications (£120.3 million). Insulins accounted for over 60% of the cost of drugs but comprised only 23% of prescriptions. Metformin accounted for 40% of prescriptions but comprised only 7% of the total medication bill. Since 1991, the proportion of total prescribing accounted for by metformin has doubled, while that for sulphonylureas has decreased by almost half. In 2004, spending on glitazones (£50.6 million) was higher than on metformin (£22.6 million) or sulphonylureas (£40.1 million).
Even in a very affluent country, such large increases in spending place considerable pressure on health service budgets. Developing countries would have considerably more difficulty in covering such high prescribing costs, even though hypoglycemic agents are essential in controlling the complications of diabetes. In recent years antiretroviral drugs have been made available to patients in developing countries at low cost, representing a great advance in the management of HIV infection. Perhaps the time has come for a similar scheme for drugs to manage diabetes and its complications in developing countries.
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