International Journal of Clinical Case Reports 2024, Vol.14, No.5, 253-261 http://medscipublisher.com/index.php/ijccr 257 those who have multiple comorbidities, such as heart failure and cardiovascular disease, to maximize cardiovascular and renal protection (Azoulay et al., 2023). 7 Cost-Effectiveness and Accessibility 7.1 Economic evaluation of novel antidiabetic drugs Recent studies on the cost-effectiveness of SGLT2 inhibitors and GLP-1 receptor agonists suggest that these drugs, despite their higher initial cost, provide long-term cost savings by reducing the incidence of diabetes-related complications, such as cardiovascular and renal events. newer antidiabetic medications, including SGLT2 inhibitors and GLP-1 receptor agonists, are cost-effective compared to traditional therapies like insulin or sulfonylureas, primarily due to their ability to prevent costly complications. A U.S.-based study indicated that adding SGLT2 inhibitors to dual therapy with metformin and DPP-4 inhibitors could improve survival and quality-adjusted life-years (QALYs) while being associated with cost savings of $9,511 per patient over a lifetime (Pawaskar et al., 2021). 7.2 Accessibility in low and middle-income countries Access to newer antidiabetic drugs in low and middle-income countries (LMICs) remains a significant challenge due to their high cost and limited inclusion in national formularies. A study published in The Lancet evaluated the price targets for SGLT2 inhibitors and GLP-1 receptor agonists to make them cost-effective in LMICs. The study found that, to achieve cost-effectiveness, SGLT2 inhibitors would need to be priced at $224 per person per year, while GLP-1 receptor agonists would require a price of $208 per person per year (Rothenberger et al., 2021). These targets represent significant reductions from current prices and highlight the need for global initiatives to lower drug prices in LMICs. 7.3 Strategies to improve drug affordability To improve the affordability of novel antidiabetic drugs, especially in LMICs, several strategies have been proposed. These include negotiating lower drug prices through bulk purchasing agreements, promoting the local production of generics, and advocating for the inclusion of these drugs in national essential medicines lists (Tonelli and Straus, 2022). Expanding the use of value-based pricing models, where drug prices are tied to their demonstrated clinical benefits, is another approach that could help make these drugs more accessible. Additionally, initiatives like the Clinton Health Access Initiative have focused on reducing the prices of essential medicines, including SGLT2 inhibitors, in LMICs, potentially making these drugs more affordable and widely available (Rothenberger et al., 2021). 8 Future Directions in Antidiabetic Drug Development 8.1 Next-generation antidiabetic drugs The development of next-generation antidiabetic drugs focuses on designing agents with improved efficacy, reduced side effects, and more targeted mechanisms of action. One promising area involves the development of "smart" insulin analogs that can automatically adjust insulin delivery based on blood glucose levels, thereby minimizing the risk of hypoglycemia. These glucose-responsive analogs could revolutionize diabetes management by offering a more precise and physiological control of blood glucose (Jarosinski et al., 2021). Another direction is the creation of combination therapies that exploit different mechanisms of action, such as combining insulin analogs with GLP-1 receptor agonists, or SGLT2 inhibitors, to provide both glycemic control and cardiovascular protection (Levina and Lay, 2020). 8.2 Personalized medicine in diabetes management Personalized medicine is transforming diabetes care by allowing for more tailored treatment approaches based on an individual's genetic makeup, environmental factors, and lifestyle. The emerging field of pharmacogenomics is particularly important, as it allows clinicians to predict how a patient will respond to specific glucose-lowering medications, thereby optimizing drug efficacy and reducing the risk of adverse effects (Scheen, 2016). Advances in next-generation sequencing (NGS) and biomarkers will likely allow for even more personalized treatment strategies, enabling clinicians to adjust treatments based on genetic variations that influence drug metabolism and response (Linsley et al., 2021).
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