Patient choice stops at inhaled insulin

The Lancet ^ | 29 April 2006 | NA

[neverdem]

When the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products licensed Pfizer's Exubera as the first inhaled insulin this year, it was welcomed as the most important development in diabetes treatment since the advent of insulin in the 1920s. Inhaled insulin had shown similar efficacy, but better quality of life scores and patient preference profiles, to short-acting subcutaneous insulin in several randomised studies in patients with type 1 and type 2 diabetes. Data on adverse events led to Exubera being contraindicated for smokers and not recommended for people with underlying lung diseases, such as asthma or COPD. Last week, the UK's National Institute for Health and Clinical Excellence (NICE) released its appraisal document on inhaled insulin, open for consultation until May 10, which concluded that the treatment should not be offered to patients.

NICE supported its conclusion with three main arguments: that the data on quality of life and patient preferences are insufficient and not generalisable; expert views that “using injected insulin is not usually a concern for the majority of people with diabetes”; and, in a rather curious conclusion, NICE claims that the effect that patients might move on to inhaled insulin earlier and therefore avoid or delay long-term diabetic complications, is “insufficient to provide support for a cost-effective use of this technology”.

Inhaled insulin will cost an additional £500 per patient per year. Clearly, it is not suitable for everyone with diabetes. For the group that might arguably benefit most from avoiding or minimising injections—children and adolescents—there is currently insufficient evidence on efficacy and safety. Long-term safety data are still lacking in terms of lung damage and effects on the development of insulin antibodies. With these caveats in mind, however, it should be left to the individual physicians in discussion with their patients to make appropriate use of this new technology.

[neverdem]

Long-term safety data are still lacking in terms of lung damage and effects on the development of insulin antibodies.

That's legitimate.

Inhaled insulin will cost an additional £500 per patient per year.

That's socialized medicine.