[Ip-health] 4 Diabetes Drugs Are Seen Raising Hope and Profit

[Andy Gray]

Hi Jamie

In response to your question, a lot would depend on the benefits that might=
 accrue from such new antidiabetics. If we focus only on the type 2 variant=
, our experience in recent years with new classes has been less than exciti=
ng - the alpha glucosidase inhibitor acarbose (sold here by Bayer as Glucob=
ay) has a marginal place in management; the thiazolidinediones such as piog=
litazone (Eli Lilly's Actos) and rosiglitazone (GSK's Avandia) are expensiv=
e add-ons to conventional therapy and are associated with worrying liver to=
xicity; the meglitinides, such as nateglinide (Novartis' Starlix) and repag=
linide (Novo's NovoNorm) are expensive alternatives to the sulphonylureas. =
In our market, there are generic equivalents of metformin (used here for ma=
ny more years than in the US, where registration was delayed) and many of t=
he sulphonylureas (such as glibenclamide (glyburide in the US), gliclazide =
and even glimepiride). Only glipizide (Pfizer's Minidiab) has no generic co=
mpetition at present. Prices are keen, in the region of $6 to $10 per month=
 (single exit price to all sellers apart from the State; i.e. before pharma=
cy mark-up, which is in transition at present, but would not exceed 36%) fo=
r generics and perhaps twice that for innovator brands. The meglitinides co=
st twice that again.

We would first have to consider the impact on hard outcomes (death, develop=
ment of complications), the incremental gains in relation to conventional t=
herapy and then the incremental costs involved. That said, I would expect m=
any of these new agents to be registered in South Africa almost as soon as =
in the US, catering for a particular segment of the insured market (at most=
 14% of the population). The public sector will, however, not adopt this ne=
w technology until the data to support such a move are available and the pr=
ices reasonable. If the gains are not worth it clinically, no price will be=
 low enough.

regards
Andy

~~~~~~~~~~~~~~~~~~~
Andy Gray MSc(Pharm) FPS
* Senior Lecturer
Dept of Therapeutics and Medicines Management
* Study Pharmacist
Centre for the AIDS Programme of Research
in South Africa (CAPRISA)
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
PBag 7 Congella 4013
South Africa
Tel: +27-31-2604334/4298 Fax: +27-31-2604338
email: graya1@ukzn.ac.za or andy@gray.za.net

>>> James Love <james.love@cptech.org> 2006/06/22 05:29 PM >>>
Re: Byetta, Exubera, Galvus and Januvia.  Does anyone have any
thoughts on the importance of promoting access to these diabetes
medicines in developing countries?  Jamie



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