scholarly journals Long-acting insulin in a public health system: analysis of compliance with clinical protocol in public pharmacies

2021 ◽  
Vol 26 (6) ◽  
pp. 2301-2310
Author(s):  
Tadeu Uggere de Andrade ◽  
Fabrício Soares Moreira ◽  
Karla Oliveira dos Santos Cassaro ◽  
Manuela Martins Cruz ◽  
Girlandia Alexandre Brasil ◽  
...  
Keyword(s):  
Public Health ◽  
Blood Glucose ◽  
Health Service ◽  
Health System ◽  
Public Health System ◽  
Insulin Analogues ◽  
Clinical Protocol ◽  
Acting Insulin ◽  
Long Acting ◽  
Hba1c Levels

Abstract Diabetes mellitus (DM) is a chronic disease marked by elevated blood glucose levels. Controlling DM involves adequate diet, physical exercises, medicines and monitoring the blood glucose and glycated hemoglobin (HbA1c) levels. This was a retrospective study of the process of dispensing long-acting insulin analogues to users with diabetes (types 1 and 2) who were registered at high-cost public pharmacies in public health system in a southeast state of Brazil, that sought to evaluate the fulfillment of the criteria of all the clinical protocol to provide these analogs. Of the 987 users registered in the health service, 315 met the inclusion criteria for the study. The evaluation of the dispensing processes of the long-acting insulin analogues revealed that the inclusion, exclusion, and suspension criteria of the protocol related with these insulin analogues were in some extend only partially fulfilled. Additionally, there was no difference between the initial and final fasting glycemic and HbA1c levels. It is concluded that the established criteria for dispensing long-acting insulin analogues were partly fulfilled by pharmacies, compromising the rational use of these analogues. It can directly impact the cost of maintaining the public health service and users’ health.

VP53 Long-Acting Insulin Analogues In Brazil: Clinical And Economic Impact

2019 ◽  
Vol 35 (S1) ◽  
pp. 88-88
Author(s):  
Lays Pires Marra ◽  
Daniel da Silva Pereira ◽  
Gustavo Laine Araújo de Oliveira
Keyword(s):  
Economic Impact ◽  
Budget Impact ◽  
Severe Hypoglycemia ◽  
Insulin Analogues ◽  
Insulin Regimen ◽  
Nocturnal Hypoglycaemia ◽  
Nph Insulin ◽  
Acting Insulin ◽  
Long Acting ◽  
Hba1c Levels

IntroductionThe aim was to evaluate the effectiveness, safety and economic impact of long-acting insulin analogues (LAIA) compared to NPH for type 1 diabetes mellitus (DM1).MethodsA search was performed in five electronic databases to find systematic reviews (SR) comparing at least a LAIA to NPH insulin for DM1. Budget impact analysis was performed from the perspective of Brazilian public health system (SUS), with NPH insulin as the base scenario. The costs were extracted from the Integrated System of Administration of General Services (SIASG). The market share was calculated per month, using a logarithmic function with maximum diffusion of 50% at the end of the time horizon - five years.ResultsA total of 160 studies were identified and seven SR of low to uncertain risk of bias were selected. LAIA have shown modest clinical benefit and its effect is more prominent for the control of severe and nocturnal hypoglycaemia. Insulins glargine and detemir compared to NPH were associated with reduction in HbA1c levels between 0.16% and 0.40% and associated with lower risk of episodes of severe hypoglycemia. Insulin degludec compared to NPH showed no statistically significant difference in the reduction of HbA1c levels and in the episodes of severe hypoglycemia. The budget impact ranges from USD 210 million (detemir) to USD 670 million (degludec) over five years.ConclusionsThe use of LAIA as a basal insulin regimen for DM1 may benefit more patients with recurrent episodes of hypoglycemia. However, the fragility of the outcomes considered to evaluate the clinical impact of LAIA and the high budget impact with its use should be considered, and may compromise SUS sustainability. In view of these aspects, CONITEC recommended the incorporation of one of the LAIA, if the treatment is equal to or less than that of NPH insulin and according to the criteria established by a guideline.

scholarly journals Clinical Protocol Standardized in a Public Health System Using a Prototype for Actinic Keratosis and Field Cancerization Treatment

2016 ◽  
Vol 4 (2) ◽  
pp. 407-410 ◽  
Author(s):  
Ana G. Salvio ◽  
◽  
Elisangela R. de Oliveira ◽  
Dora P. Ramirez ◽  
Kate C. Blanco ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Actinic Keratosis ◽  
Public Health System ◽  
Field Cancerization ◽  
Clinical Protocol

India as a Pioneer of Innovation

2018 ◽  
Keyword(s):  
Public Health ◽  
Health System ◽  
Informal Economy ◽  
Urban Poor ◽  
Public Health System ◽  
Low Cost ◽  
Social Enterprises ◽  
Specific Context ◽  
Innovation Project ◽  
Context Specific

What does innovation mean to and in India? What are the predominant areas of innovation for India, and under what situations do they succeed or fail? This book addresses these all-important questions arising within diverse Indian contexts: informal economy, low-cost settings, large business groups, entertainment and copyright-based industries, an evolving pharma sector, a poorly organized and appallingly underfunded public health system, social enterprises for the urban poor, and innovations for the millions. It explores the issues that promote and those that hinder the country’s rise as an innovation leader. The book’s balanced perspective on India’s promises and failings makes it a valuable addition for those who believe that India’s future banks heavily on its ability to leapfrog using innovation, as well as those sceptical of the Indian state’s belief in the potential of private enterprise and innovation. It also provides critical insights on innovation in general, the most important of which being the highly context-specific, context-driven character of the innovation project.

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