Expanding Access to New Medicines for People with Type 2 Diabetes in Low- and Middle-Income Countries: A Cost-Effectiveness Analysis and Price Target



For patients with type 2 diabetes in low- and middle-income countries (LMICs), access to newer diabetes drugs (for example, sodium-glucose-2 co-transporter [SGLT2] inhibitors, glucagon-like peptide-1 [GLP-1] insulin receptor agonists and analogues) may reduce the incidence of complications from diabetes. Our objective was to estimate the price targets to be pursued in the negotiations for inclusion in national formulas given the addition of these new agents to the WHO list of essential drugs.


We incorporated nationally representative survey data (2006-18) from 23,678 people with diabetes in 67 PRFI in a microsimulation of cardiovascular events, heart failure, end-stage renal failure, loss of blood. vision, loss of pressure, hypoglycemia requiring medical examination. attention and drug-specific side effects. We estimated price targets for the incremental costs of switching to newer treatments to achieve cost-effectiveness (i.e.


To be cost-effective, SGLT2 inhibitors should have a median price of $ 224 per person per year (a cost reduction of 17.4%; IQR of $ 138-359, weighted by population in all countries; average price $ 257); GLP-1 receptor agonists $ 208 per person per year (98.3% reduction; $ 129 to 488; $ 240); and insulin glargine $ 20 per vial (31.0% reduction; $ 16-42; $ 28). To achieve net savings, the price targets should be reduced by an additional $ 9-10 at a median cost for SGLT2 inhibitors of $ 214 (21.4% reduction; $ 148 to $ 316; $ 245) and for SGLT2 inhibitors. GLP-1 receptor agonists at $ 199 per person per year (98.4% reduction; $ 138 to $ 294; $ 228); but insulin glargine remained at around $ 20 per vial (32.4% reduction; $ 15-37; $ 26). Use of SGLT2 inhibitors or GLP-1 receptor agonists in a blood glucose independent pathway produced a reduction of 92% (SGLT2 inhibitors) and 72% (GLP-1 receptor agonists) incremental cost-effectiveness.


Among the new agents, SGLT2 inhibitors show particular promise in reducing complications of diabetes and achieving common price targets, particularly when used in people with established cardiovascular or kidney disease. These results are consistent with the choice to include SGLT2 inhibitors in the WHO list of essential drugs.


Clinton Health Access Initiative.


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