NHS mass overspend on insulin

A joint investigation from the British Medical Journal (BMJ) and Channel 4 News has suggested the NHS has wasted £250m on insulin treatments over the past five years.

The claims are based on the increased use of more expensive analogue insulins over older human insulins to treat the 2.8m people diagnosed with diabetes in the UK.

Analogue insulins are modern insulins that are restructured at a molecular level to deliver the treatment either more rapidly or slowly depending on a patient's need.

The investigation, however, suggested that analogue insulins were not a cost-effective treatment, citing systematic reviews and analysis that found in almost all classes of insulin, clinical benefits for patients were not proportionality beneficial.

In the UK, a daily maintenance dose of analogue insulin costs over twice as much as that of a human insulin. Despite the treatment's expense, its use has increased in the country by 116 per cent since 2004/2005, with 80 per cent of all insulins used in the UK now analogue versions.

In a response to the investigation, the National institute for Health and Clinical Excellence (NICE) said: "NICE advises doctors to prescribe human insulin as the treatment of choice for people with diabetes. A recent health technology assessment concluded that, in type-2 diabetes, analogue insulins weren't worth what the NHS was being charged in most cases."

The organisation also referred to published evidence which suggests, that although analogues have marginal benefits in terms of convenience, reduced weight and reduced risk of hypoclycaemia, they do not improve overall glucose control or safety in type-2 diabetes.

Dr Amanda Adler, a diabetes expert at the University of Oxford, said: "I would estimate that around 90 per cent of people with type 2 diabetes would probably do quite well on these human insulins compared with the long-acting insulin analogues."

The Department of Health (DH) backed NICE guidance on the issue, stating: "We would expect clinicians to take into account NICE's clinical guidelines on type 2 diabetes when prescribing decisions are made."

Defending the use of analogue insulins, Dr Andrew Hockey, director of medical operations, sanofi-aventis UK, makers of analogue insulin Lantus, told Channel 4 New: "Using modern insulins you have to look beyond the cost of the insulins in itself.

"It's allowed treatment to move out of hospitals back into GP's surgeries and we know that is a cheaper place to treat diabetes."

According to the BMJ, diabetes is the fourth biggest worldwide therapeutic class, generating sales in 2009 of £19bn. The condition is estimated to take up around 10 per cent of the NHS' budget – around £9bn.