Estimated Sustainable Cost-Based Prices for Diabetes Medicines

Abstract

ImportanceThe burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-income countries. The prices of diabetes medicines are a key determinant for access, yet little is known about the association between manufacturing costs and current market prices.ObjectivesTo estimate the cost of manufacturing insulins, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and glucagonlike peptide 1 agonists (GLP1As), derive sustainable cost-based prices (CBPs), and compare these with current market prices.Design, Setting, and ParticipantsIn this economic evaluation, the cost of manufacturing insulins, SGLT2Is, and GLP1As was modeled. Active pharmaceutical ingredient cost per unit (weighted least-squares regression model using data from a commercial database of trade shipments, data from January 1, 2016, to March 31, 2023) was combined with costs of formulation and other operating expenses, plus a profit margin with an allowance for tax, to estimate CBPs. Cost-based prices were compared with current prices in 13 countries, collected in January 2023 from public databases. Countries were selected to provide representation of different income levels and geographic regions based on the availability of public databases.Main Outcomes and MeasuresEstimated CBPs; lowest current market prices (2023 US dollars).ResultsIn this economic evaluation of manufacturing costs, estimated CBPs for treatment with insulin in a reusable pen device could be as low as $96 (human insulin) or $111 (insulin analogues) per year for a basal-bolus regimen, $61 per year using twice-daily injections of mixed human insulin, and $50 (human insulin) or $72 (insulin analogues) per year for a once-daily basal insulin injection (for type 2 diabetes), including the cost of injection devices and needles. Cost-based prices ranged from $1.30 to $3.45 per month for SGLT2Is (except canagliflozin: $25.00-$46.79) and from $0.75 to $72.49 per month for GLP1As. These CBPs were substantially lower than current prices in the 13 countries surveyed.Conclusions and RelevanceHigh prices limit access to newer diabetes medicines in many countries. The findings of this study suggest that robust generic and biosimilar competition could reduce prices to more affordable levels and enable expansion of diabetes treatment globally.

Error in Reported Number of Countries

“…In the Original Investigation titled “Estimated Sustainable Cost-Based Prices for Diabetes Medicines,” 1 published March 27, 2024, there was an error in the number of countries reported. Each instance of “13 countries” should have been “12 countries.” In the Methods, the listing of countries from which current market prices were collected given as “Indonesia, Morocco, South Africa, and Ukraine” should have omitted Indonesia and Ukraine and added “the Philippines.” Data from Indonesia were indeterminate and therefore not included in the final analysis.…”