Bonyani Atousa, Lin Tracy K, Jakira Ambrose, Kimera Isaac D, Muddu Martin, Schwartz Jeremy I, Kahn James G
Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America.
Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, San Francisco, California, United States of America.
PLoS One. 2025 Jun 25;20(6):e0326806. doi: 10.1371/journal.pone.0326806. eCollection 2025.
The World Health Organization suggests selecting essential medicines based on availability, accessibility, affordability, cost-effectiveness, and safety and efficacy. We examined Oral Hypoglycemic Agents (OHAs) for type 2 diabetes mellitus in the Essential Medicines and Health Supplies List for Uganda (EMHSLU), assessed all criteria, and proposed alternative medicines to improve cost-savings and health outcomes.
We conducted a literature review followed by budget impact analysis (BIA) to evaluate potential cost-savings from refining EMHSLU. In our literature review, we identified metrics for measuring availability, accessibility, and affordability of medicines and evaluated evidence on cost-effectiveness, safety, and efficacy of OHAs. According to the country context and available data, we used applicable methods to analyze five classes of OHAs available in Uganda. Since the government covers essential medicines in the public sector based on BIA, we assessed affordability for the government by examining potential savings in two scenarios (#1: shifts within the EMHSLU; #2: use of non-EMHSLU drugs).
OHAs added to the EMHSLU 2023 are less available and accessible compared to OHAs in EMHSLU 2016. BIA scenario 1 revealed that the complete replacement of glimepiride 2 mg and gliclazide 80 mg with glibenclamide 5 mg could save the government up to USD 2.65 million per year. Additionally, scenario 2 showed that full replacement of dapagliflozin 10 mg and glimepiride 4 mg instead of their lower doses can save up to United States Dollar (USD) 230,000 and USD 600,000 per year, respectively. A review and adaptation of a published cost-effectiveness analysis highlights that sitagliptin is a cost-effective OHA in Uganda with an estimated Incremental Cost Effectiveness Ratio of $6,132/Quality-Adjusted LifeYear.
The findings suggest several potential type 2 diabetes oral medication substitutions which would reduce costs.
世界卫生组织建议根据可获得性、可及性、可负担性、成本效益以及安全性和有效性来选择基本药物。我们对乌干达基本药物和卫生用品清单（EMHSLU）中的2型糖尿病口服降糖药（OHAs）进行了研究，评估了所有标准，并提出了替代药物以提高成本节约和健康结果。
我们进行了文献综述，随后进行预算影响分析（BIA），以评估优化EMHSLU可能带来的成本节约。在文献综述中，我们确定了衡量药物可获得性、可及性和可负担性的指标，并评估了OHAs成本效益、安全性和有效性的证据。根据该国情况和现有数据，我们采用适用方法分析了乌干达可用的五类OHAs。由于政府根据BIA覆盖公共部门的基本药物，我们通过研究两种情景（情景1：EMHSLU内的替换；情景2：使用非EMHSLU药物）下的潜在节省来评估政府的可负担性。
与2016年EMHSLU中的OHAs相比，2023年添加到EMHSLU中的OHAs可获得性和可及性较低。BIA情景1显示，用5毫克格列本脲完全替代2毫克格列美脲和80毫克格列齐特每年可为政府节省高达265万美元。此外，情景2表明，分别用10毫克达格列净和4毫克格列美脲完全替代其较低剂量每年可分别节省高达23万美元和60万美元。对已发表的成本效益分析进行的回顾和调整突出表明，西他列汀在乌干达是一种具有成本效益的OHAs，估计增量成本效益比为6132美元/质量调整生命年。
研究结果表明了几种可能降低成本的2型糖尿病口服药物替代方案。
