1. Comparison of cost implication of intermediate acting insulin (insulatard) and long acting insulin (glargine) for one month use to patient.
Glargine : long acting insulin marketed by Sanofi Aventis current price per pen is #2,200 (company’s price)
Insulatard: intermediate acting insulin marketed by Novo Nordisk current price per vial is #2,600 (company’s price)

2. Novotwist needle is needed for administering glargine market price is #60
Insulin syringe and needle needed administering insulatard market price of both is #20

3. If an hypothetic patient Mr A is to be using 10 i
If an hypothetic patient Mr A is to be using 10 i.u of insulatard at bedtime daily for a month and another hypothetic patient Mr B is to be using 10 i.u of glargine nocte for a month.
To find out the cost implications for both Mr A and Mr B using prevailing market prices for insulin types over a month period.

4. Price now in Luth pharmacy is #3,000 per vial

5. A vial comes in 10mls and contains 1,000i
A vial comes in 10mls and contains 1,000i.u of intermediate acting insulin (insulatard)
A cartridge comes in 3mls and contains a 300i.u of long acting insulin (glargine)

6. PRICES FROM LUTH A&E PHARMACY
For Mr A on 10i.u of insulatard at bedtime for one month (he will need one vial of insulatard and 30 insulin needles and syringes) Total monthly cost will be #2,220 * 1 + #20 * 30= #2,220 + #600 = #2,820 per month
For Mr B on 10i.u of glargine nocte for one month (he will need one pen of glargine and 30 pieces of novotwist needles) Total monthly cost will be #2,650 * 1 + #50 * 30 = #2,650 + #1,500 = #4,150 per month

7. IF BOTH PATIENTS’ INSULIN REQUIREMENTS ARE INCREASED TO 20I
IF BOTH PATIENTS’ INSULIN REQUIREMENTS ARE INCREASED TO 20I.U: COST IMPLICATIONS
Mr. A is now on 20i.u of insulatard in two divided doses daily for a month duration (he will need a vial and 60 insulin needles and syringes) Total monthly cost will be #2,220 * 1 + #20 *60 = #2, #1,200 = #3,420 per month
Mr. B is now on 20i.u of glargine nocte for a month duration (he will two pens and 30 novotwist needles) Total monthly cost will be
#2650 * 2 + #50 * 30 = #5,300 + #1,500 = #6,800 per month

8. INFERENCES
As the insulin requirement doubles, the price of getting of glargine (#6,800) doubles that of procuring equivalent dose of insulatard (#3,420).
Daily and single dosing of glargine is more likely to be favoured by more patients as against insulatard which may require twice dosing owning limited 24hours coverage.
Portability, fanciful design and near painless nature of glargine could still favour its use over insulatard among patients.

9. Draw backs
1. Cost of transportation to and fro from patient’s home to insulin purchase point was not accounted for.
2. cost of implication for refrigerator storage of insulatard for one month was not considered. N.B …. it should be noted that glargine needs no refrigeration once it is opened for USE and ideally, it should be use strictly for 28days only.
3. Technical wastage of insulin needle due bending necessitating immediate replacement and ill potency experienced owning improper refrigeration.

10. THANK YOU SIR !