The Budgetary Impact of Diabetic Comorbidities in Brazil and Mexico - How Little is Being Done to Measure and Control It

The type 2 diabetes (T2D) therapy market is often tied to a high commercial opportunity. Indeed, when we look at key Latin American markets such as Brazil and Mexico -- each with over 14 million prevalent cases of T2D and growing, and Mexico with one of the highest prevalence rates in the world -- it is unsurprising that Brazil’s and Mexico’s total pharmaceutical market for type 2 diabetes rival the size of some of the more mature markets. With the majority of patients in Brazil and Mexico relying on government sponsorship to some extent in accessing drug treatments, a large proportion of the drug spending falls under the responsibility of the countries’ public healthcare systems. Moreover, the financial burden associated with T2D is further aggravated once one considers the added costs of treating the comorbidities frequently presented by the diabetic patient.

Proper and continued management of HbA1c is believed to prevent most diabetic comorbidities. However, multiple factors -- including ineffective T2D treatment, limited access to more-effective but yet premium-priced therapies, and poor patient compliance to available treatments -- often drive progression to and within comorbidities. For example, progression to diabetic retinopathy (DR) and diabetic nephropathy (DN) can have catastrophic consequences on patients’ health and the national healthcare budgets. So, what are payers in these markets doing to prevent, or at least delay, the progression of T2D patients to comorbidities? One would expect that with such a high burden of concomitant disease that the Brazilian and Mexican governments would be actively promoting strategies that raise awareness of comorbidities and promote early diagnosis. Furthermore, they would push for the timely incorporation of new, more effective therapies into the T2D treatment algorithms of public healthcare institutions. Instead, a recent DRG study based on surveys of physicians and interviews with payers found that limited drug coverage in these markets constrain treatment decisions for T2D in the public sector, prolonging use of first-line metformin, as well as other older, less expensive treatments (such as sulfonylureas or regular insulins). Moreover, despite national clinical guidelines recommending screening for DR and DME at least once a year after T2D is diagnosed, continued patient management mostly at the primary levels of care prevents prompt diagnosis and the use of more effective treatments that could delay disease progression. Therefore, surveyed physicians in these markets report high rates of comorbidities and that less than one-third of patients with a specific diabetic comorbidity are well controlled on antidiabetic treatment alone, likely due to limited patient access to more-effective but also more-expensive agents. Indeed, some of the newer diabetes treatments have notable impact on the progression of certain comorbidities, without enabling progression to others. For example, both GLP-1 analogues and SGLT-2 inhibitors have demonstrated reductions in weight and in blood pressure and also have studies suggesting the attenuation of the progression of DN.

Interestingly, interviewed payers share physicians’ perception of current diabetes drugs as effective in preventing some comorbidities, and manufacturers of diabetic therapies should take advantage of this momentum in order to properly educate all parties on the benefits/drawbacks of individual treatments on the different comorbidities. Moreover, payers from both Brazil and Mexico recognize that DR and especially DN (as well as other CV diseases) have a huge financial impact on their institutions. However, they have no institutionalized approach to systematically measure data capturing this reality and ultimately, T2D and comorbidities are managed separately. The lack of systematic data on the prevalence and treatment costs of diabetic comorbidities (i.e., the overall financial impact of T2D) is likely the greatest barrier to implementing alternative, more effective treatments for T2D in public healthcare institutions in Brazil and Mexico which are already seeing their budgets drained in the management of comorbidities instead of investing in preventive actions when diabetes can’t be prevented any longer.

Clearly these governments need help establishing the relationship between the incidence and costs of treating the diabetic comorbidities and the poor management of T2D patients, to properly allocate budgets and make informed coverage decisions. As local and national governments bear the burden of treating a growing population with the disease and related comorbidities, it remains to be seen if the treatment algorithm for T2D in these countries will advance as the treatment armamentarium evolves, or if it will stagnate even though more effective, yet more expensive therapies become available in these markets.

To know more on DRG’s coverage of the Latin American Market Access Landscape for drug treatments for T2D and associated comorbidities, and other diseases, follow Andreia on Twitter at @ARibeiroDRG