COST COMPARISON OF ORAL ANTIDIABETIC AGENTS AND INSULIN: EVALUATING AFFORDABILITY AND THE SHIFT TO INSULIN THERAPY IN RESOURCE-LIMITED SETTINGS

Abstract

Introduction: The economic burden of type 2 diabetes treatment poses significant challenges, particularly in resource-limited settings. This study aimed to compare the cost variations between oral antidiabetic drugs (OADs) and insulin formulations in India, with a focus on affordability and the potential shift to insulin therapy in patients with inadequate glycemic control on dual OADs.

Methods: Price data for commonly prescribed OADs—including metformin, teneligliptin, voglibose, vildagliptin, sitagliptin, repaglinide, tolbutamide, miglitol, pioglitazone, acarbose, glibenclamide, gliclazide, glimepiride, glipizide, linagliptin, and dapagliflozin—were collected from the Current Index of Medical Specialties (CIMS) and verified online sources. Cost per unit and 30-day treatment costs were calculated. Similarly, prices of insulin formulations such as NPH, regular insulin, and biphasic insulin were analyzed for economic feasibility.

Results: OADs displayed wide cost variability. Metformin remained the most affordable (INR 20.7–297), while newer agents like linagliptin (INR 225–1545) and dapagliflozin (INR 150–900) were significantly more expensive. Teneligliptin, vildagliptin, voglibose, and other sulfonylureas also showed substantial price ranges. In contrast, insulin formulations, particularly NPH and regular insulin, were relatively affordable, with prices ranging from INR 129.84 to 490 per 10 mL vial. Insulin delivery devices were inexpensive (INR 4.60–4.70 per unit).

Conclusion: Insulin therapy offers a more cost-effective alternative for patients failing dual OAD therapy. Shifting to insulin could improve affordability and adherence, especially in low-income populations. Policy-level interventions like price regulation and improved access are crucial for effective diabetes management.