Fortis Healthcare study finds substantial escalation in the overall cost of treating diabetes in India

World Diabetes Day 14 November 2017

• Insulin (especially newer insulins) sales rise from 151 cores in 2008 to 842 crores in 2016; oral drug (especially newer) sales go up from 278 crores in 2013 to 700 crores in 2016
• Study on nationwide trends in sales conducted over 9 years questions the cost effectiveness of new, expensive diabetic drugs even as accessibility of healthcare for the poor remains grossly inadequate

New Delhi, November 14, 2017:  A study on the nationwide trends in the sales of antidiabetic oral drugs and insulins was led by Dr. Prof Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Specialities and President, National Diabetes Obesity & Cholesterol Foundation (N-DOC). The research aimed to study sales trends of all top selling drugs (20 brands) for the past 9 years (between December 2008 and December 2016), with emphasis on antidiabetic drugs.

The study assessed the overall trends in drug sales and changes in prescription patterns of older versus new OADs and insulins. Standard validation methods were employed for data extraction and computation. Data was extracted from All Indian Origin Chemists & Distributors Ltd.’s (AIOCD) pharma data platform. It has about 60,000 distributors and seven lakh chemists under its fold in India. Sales records, including secondary sales were tracked every month from pharmaceutical stockists and distributors.

 Key findings:

• Between 2008 to 2012, sales of insulins increased from INR 151.2 crores to 218.7 crores (44% growth). Primary reasons for this includes reduced inertia of patients and physicians to use insulin, more patients with diabetes related complications and aggressive marketing by pharmaceutical companies. In this context, it is also important to note that chronic kidney disease due to diabetes is more prevalent among Asian Indians, and increasingly being diagnosed, necessitating insulin therapy in a greater number of patients.
• Insulin sales continued to see an upward trend between 2012 and 2014 with sales more than doubling from INR 218.7 crores to 467.8 crores (114% growth) possibly due to increased availability and aggressive marketing of newer insulin analogues. Between 2014-2016, sales of insulin continued to see a substantial upward trend from INR 467.8 crores to 842 crores (80% growth) probably due to the availability of new basal insulin and newer premix insulin to the armamentarium.
• From 2013 to 2015 the sales of OADs increased rapidly from INR 278.5 crores to 570.9 crores (105% growth). This was because of the introduction of new drugs, combination drugs, and more affordable drugs that were manufactured by the Indian pharmaceuticals.  Between 2015 and 2016 OAD sales went up from INR 570.9 to INR 700 crores (23% growth) mainly due to the aggressive marketing strategies that were employed by companies.
• Substantial spurt in expensive treatment of diabetes for both insulins and OADs is noteworthy. Primary attributable reasons are huge increase in the sale of newer and more expensive drugs and insulins and is incongruous with poor availability and accessibility of basic healthcare particularly for people among the lower socio-economic strata. Although listed by WHO in the essential list of drugs, only 35-63% of primary health centres stock the most basic oral drugs for diabetes.

Dr Anoop Misra, Chairman, Fortis C-DOC Hospital for Diabetes and Allied Specialities shared, “Increasing sales of high cost medications as shown by our data are particularly worrisome since most Indians pay out of their pocket and nearly 7% experience catastrophic expenditure for diabetes. Only a bare minimum patients are covered by health insurance and even here, only the cost of hospitalization is paid by insurance companies. Indiscriminate use of newer oral drugs and insulins is often seen in India and here, Indian physicians should be made aware that newer and more expensive insulins and drugs may not always be better, and that older OADs and insulins may be equally effective if judiciously used, particularly in those who are financially challenged. Our study shows that there is substantial escalation in the overall cost of treating diabetes in India. While there is a distinct rise in the usage of newer oral drugs and insulin analogues, affordability and accessibility of anti-diabetic therapy to low socio-economic stratum remains inadequate. India has to take several stringent measures to ensure that there is a balancing mechanism in place, education of physicians, tighter regulations on price control and stricter norms for pharmaceutical companies around new drugs and marketing ethics.”

A chronic condition, diabetes occurs when the pancreas is not able to produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. A major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, diabetes cannot be prevented but can be controlled. Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are some of the ways to prevent or delay the onset of diabetes. According to the WHO, the number of diabetics has risen from 108 million in 1980 to 422 million in 2014.  Recent data highlight that deaths due to cardiovascular disease and diabetes are 27% and 4.0%, respectively, in South Asian countries. The number of people with diabetes in India is second only to China and is increasing rapidly due to economic, dietary, and lifestyle transitions. Besides urban areas, Type 2 diabetes is increasing at a worrisome rate in semi-urban and rural areas of India, particularly affecting people belonging to middle and low socioeconomic strata.