Access to drugs key to fight cost of diabetes

India ranks second after China in the global diabetes epidemic and is experiencing a shift in diabetes prevalence from urban to rural areas, the affluent to the less privileged and older to younger people. Given the lifelong expenditure associated with diabetes and its complications, it imposes a significant economic burden on the individuals, families, society, national healthcare systems and countries.

The burgeoning diabetes epidemic could have a profound impact on morbidity and mortality and lead to increased healthcare expenditure. Type 2 diabetes is the most prevalent type of diabetes and in India, it is the most important driver of the diabetes epidemic. The rate of undiagnosed diabetes remains high in most developing economies, like India, because of less developed healthcare systems.

There are at least eight different pathophysiological defects in a person with type 2 diabetes. To address each of these defects, newer drugs are becoming available. An example would be the SGLT2 group of drugs which act through the kidney. These drugs not only help in diabetes control but also in reducing weight and blood pressure. They have also been shown to be heart-friendly. However, these newer drugs at relatively higher costs mean that many may not have access to them. The challenge is to make these latest medicines also available to the common man either through subsidy from the government or through other insurance programmes.

There is a need to increase awareness about the rise in diabetes, and its staggering burden and consequences, in developing countries. A large proportion of diabetes cases are preventable. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes.

Moreover, even if one has diabetes, it is currently treatable, and its complications can be avoided. Increasing access to diagnosis, self-management education, advanced bio-pharmaceuticals, innovative devices and regularity of treatment are vital components of successful diabetes management.

Efforts to prevent and treat diabetes will be important to achieve the global Sustainable Development Goal 3 target of reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030. Many sectors of society have a role to play, including governments, healthcare experts, educators, manufacturers, civil society, private sector, policy analysts, the media and individuals themselves. A strong advocacy is required for stronger health systems to ensure improved surveillance, enhanced prevention, and more effective management of diabetes.

It must be realised that the price of new innovative drugs and devices reflects the value they bring to patients and society by treating disease more effectively and thereby averting future costs in the healthcare systems. In addition, bringing new drugs and devices to the market is a long and expensive process, often requiring billions of dollars of investment and 10-15 years of preclinical and clinical research.

Affordability can be addressed by expanding public or private insurance coverage or creating a system differential pricing. The latter means that a new drug or device introduced in a lower income market, such as India, can be priced lower than in a higher income market like the US or Japan. However, some policymakers call for price controls on patented, innovative medicines; while this may sound appealing, in the long-term, price controls reduce the incentive to invest in the research and development of new drugs and ultimately reduce patient access to the medicines they need.

To effectively address the management of diabetes in India, we need to find ways to improve the affordability and accessibility of new drugs and medical devices in a way that preserves sustained investment in R&D to bring new treatments, cures and diagnostics to patients who need them.

We need a multifactorial approach involving primary, secondary and tertiary prevention of diabetes and the engagement of multiple stakeholders — patients, healthcare providers, NGOs, the private sector and government. The economic burden of diabetes can be reduced by providing universal health coverage, access to innovative medicines and early detection and treatment of the disorder. This emphasises the need for a multi-pronged strategy to minimise the burden of diabetes and its complications. These measures could help reduce economic costs due to diabetes and related complications.

Stakeholders in the ecosystem should understand that better management of diabetes through improved medication adherence can also lead to improved health outcomes and lower costs for patients. With these tools at our disposal, the time to act is now!

(The writer is chairman and chief of Diabetology at Dr Mohan’s Diabetes Specialities Centre)