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Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities., Competing Interests: MW and JR work for HTA Consulting and MH works for Square Toiletries Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Godman, Haque, Leong, Allocati, Kumar, Islam, Charan, Akter, Kurdi, Vassalo, Bakar, Rahim, Sultana, Deeba, Khan, Alam, Jahan, Kamal, Hasin, Munzur-E-Murshid, Nahar, Haque, Dutta, Abhayanand, Kaur, Rwegerera, Nascimento, Dias Godói, Irfan, Amu, Matowa, Acolatse, Incoom, Sefah, Acharya, Opanga, Njeri, Kimonge, Kwon, Bae, Khuan, Abubakar, Sani, Khan, Hussain, Saleem, Malande, Piloya-Were, Gambogi, Hernandez Ortiz, Alutuli, Kalungia, Hoxha, Marković-Peković, Tubic, Petrova, Tachkov, Laius, Harsanyi, Inotai, Jakupi, Henkuzens, Garuoliene, Gulbinovič, Wladysiuk, Rutkowski, Mardare, Fürst, McTaggart, MacBride-Stewart, Pontes, Zara, Tagoe, Banzi, Wale and Jakovljevic.)

Background: Chronic kidney disease (CKD) patients are prone to medication-related problems (MRPs). Few studies address the clinical relevance of MRPs among CKD patients in sub-Saharan Africa., Objective: To investigate the frequency and predictors of MRPs among adult CKD patients treated at a tertiary care facility in an urban sub-Saharan setting., Setting: Kenyatta National Hospital in Nairobi, Kenya., Method: A cross-sectional study involving 60 adult patients with CKD was carried out. Data were collected through structured interviews and patient chart reviews between April 2016 and June 2016. MRPs identified from the collected data were classified according to Hepler and Strand classification. The frequencies of the identified MRPs were computed and logistic regression used to investigate the associations between the MRPs and covariates in the data., Main Outcome Measures: frequencies and predictors of MRPs., Results: 271 MRPs were identified. The commonest MRPs were drug interactions (21.8%), indication without drug (18.1%) and medication non-adherence (15.5%). Compared to patients with CKD stage 3, patients with CKD stage 4 were 5.9 times more likely to have an improper drug selection and 4.7 times more likely to experience overdosage. Other significant predictors of MRPs were the number of medications per prescription and the number of comorbidities per patient., Conclusion: This study found a high frequency of MRPs among patients with chronic kidney disease receiving care in urban sub-Saharan tertiary hospital settings. The predictors of MRPs among CKD patients in this setting are likely to be multifactorial and include the CKD stage, polypharmacy, and comorbidities.