The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future.

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.

Odontologia Legal e Forense na formação de estudantes de Odontologia: relato de experiência de projeto de ensino multidisciplinar / Legal and Forensic Dentistry in the formation of dental students: an experience report of a multidisciplinary learning project

Este artigo objetivourelataraexperiência de um projeto de ensino multidisciplinar deOdontologia Legal e Ciências Forenses,voltado aosestudantes universitários e à comunidade acadêmica em geral. O projeto,por meio de encontros quinzenais comminicursos, grupo de estudos de livros didáticoseartigos científicos, além de outras atividades, estimuloua discussão e o aprendizado dessasáreas temáticas que estão cada vez mais em foco.Com fins didáticos,foi montada uma sequência deassuntos de Odontologia Legal e Ciências Forenses, possibilitando aos estudantes a experiência da perícia criminal, a partir docontato com ensaios simples,cujos conceitos jurídicos e forenses envolvidos estão presentes no currículo vivenciado emdiferentes cursos universitários.As palestras realizadas quinzenalmentepossibilitaram ao público (graduandos e professores)a troca de conhecimento sobre asdiferentesáreas que abrangiam o projeto. Os assuntos abordados nas palestras foram especialmente importantes nas áreas que englobam as Ciências Forenses, principalmente a Química Forense e a Odontologia. O projeto de ensino intitulado: "Odontologia Legal e Forense"pode exercerum papel fundamental na formação acadêmica,tanto de futuros cirurgiões-dentistas quanto defuturos peritos, possibilitando vasto conhecimento em diferentes áreas das Ciências Forenses (AU).

It is the purpose of this paper to report the experience of a multidisciplinary teaching project of Legal Dentistry and Forensic Sciences, aimed at university students and the academic community in general. The project, through biweekly meetings with short courses, a group of textbook studies and scientific articles as well as other activities, stimulated the discussion and learning of these thematic areas that are increasingly in focus. For didactic purposes, a sequence of subjects of Legal Dentistry and Forensic Sciences was set up, allowing students to experience criminal expertise, through contact with simple essays, whose legal and forensic concepts involved are present in the curriculum experienced in different university courses. The biweekly lectures enabled the public (undergraduates and teachers) to exchange knowledge about the different areas that comprise the project. The subjects covered in the lectures are especially important in the areas that encompass Forensic Sciences, especially Forensic Chemistry and Dentistry. The teaching project entitled "Legal and Forensic Dentistry" can play a fundamental role in the academic formation, both for future dental surgeons and future experts, enabling vast knowledge in different areas of Forensic Sciences (AU).