Authors’ Reply to Dr. Malerbi: “Insulin Glargine in a Brazilian State: Should the Government Disinvest?”

Souza, Ana Luísa Caires de; Acúrcio, Francisco de Assis; Júnior, Augusto Afonso Guerra; Nascimento, Renata Cristina Rezende Macedo do; Godman, Brian; Diniz, Leonardo Maurício

doi:10.1007/s40258-014-0113-x

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…With respect to increasing the routine availability of insulins alongside reducing co-payments where concerns, it is better for countries to focus initially on increasing the availability of NPH insulins as opposed to procuring more expensive insulin analogues apart from those necessary to treat insulin resistant patients. This is because a number of published studies from academic and HTA units have not demonstrated significant differences between NPH and the more expensive long acting insulins in terms of reducing hypoglycaemia episodes or on patient's quality of life (163)(164)(165)(166)(167)(168)(169)(170). However, this finding was not universal (171).…”

Section: Discussion and Next Stepsmentioning

confidence: 99%

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

et al. 2020

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Background: Currently about 19 million people in Africa are known to be living diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. Methodology: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilising input from senior level government, academic and other professionals from across Africa. Results: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organisations, patient organisations and pharmaceutical companies. Their impact though remains to be seen. A range of activities have been documented for all key stakeholder groups to improve future care. Conclusion: There are concerns with the management of patients with T1DM across Africa. A number of activities have been suggested to address this and will be monitored.

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Section: Discussion and Next Stepsmentioning

confidence: 99%

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

et al. 2020

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“…Six articles reported four instances of non–evidence-based use of health technologies in Brazil, Colombia, and Uruguay, meaning that funding the health technologies under consideration might not represent the most appropriate allocation of resources in those particular settings (Table 2) (12–17). However, only in one of these programs, reported in three articles, was active disinvestment suggested (12;16;17). These three articles referred to an SLR conducted to assess the effectiveness of insulin glargine in patients with type 1 diabetes mellitus; the original study showed no added benefit for insulin glargine, and the authors explicitly recommended the State Government of Minas Gerais, Brazil, delisting of insulin glargine or negotiating a price reduction (12).…”

Section: Resultsmentioning

confidence: 99%

“…These three articles referred to an SLR conducted to assess the effectiveness of insulin glargine in patients with type 1 diabetes mellitus; the original study showed no added benefit for insulin glargine, and the authors explicitly recommended the State Government of Minas Gerais, Brazil, delisting of insulin glargine or negotiating a price reduction (12). The additional two articles were published commentaries on the original article (16;17). The other three cases identified reported the use of ineffective or harmful medicines and medical practices in Brazil, Uruguay, and Colombia (Table 2) (13–15).…”

Section: Resultsmentioning

confidence: 99%

Status of Disinvestment Initiatives in Latin America: Results From a Systematic Literature Review and a Questionnaire

Agirrezabal

Burgon

Stewart

et al. 2017

Int J Technol Assess Health Care

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Authors’ Reply to Dr. Malerbi: “Insulin Glargine in a Brazilian State: Should the Government Disinvest?”

Cited by 2 publications

References 11 publications

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

Status of Disinvestment Initiatives in Latin America: Results From a Systematic Literature Review and a Questionnaire

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