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 Metformin, an older generic drug to help lower blood sugar, was
available in all of the pharmacies researchers checked in
high-income countries and in India, for example. But it was stocked
in just 65 percent of other low-income countries excluding India.
And metformin was affordable for more than 99 percent of patients in
wealthier nations, compared with 73 percent in poor countries,
researchers report in Lancet Diabetes & Endocrinology.
"The actual price of diabetes medicines are pretty similar across
countries, and the key reason for them being unaffordable in lower
income countries is that people's incomes in absolute terms in these
countries is lower," said lead study author Clara Chow of the
University of Sydney in Australia.
"Health insurance plans can help cover poor people in high-income
countries, but they may not exist to protect the poor in low-income
countries," Chow said by email.
Researchers considered drugs affordable when patients spent less
than 20 percent of their household income available after food
expenditures on medications.
To assess how often drugs were affordable or available, researchers
examined data collected in pharmacies and from surveys of more than
156,000 people, ages 35 to 70, in 604 communities across 22
countries.
In addition to metformin, they also looked at insulin and
combination therapy with these drugs and other diabetes pills.
Insulin was available in 94 percent of pharmacies in high-income
countries, in 76 percent of pharmacies in India, and in only about
10 percent of pharmacies in low-income countries excluding India.
About three percent of households in high-income countries and 63
percent of households in low-income countries could not afford
insulin, the study found.
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Among the roughly 14,000 people in the study with diabetes, 74
percent of patients in high-income countries took medications to
manage the condition, compared with just 30 percent of patients in
low-income countries.
Globally, almost one in 10 adults has diabetes, according to the
World Health Organization. Most have type 2 diabetes, which is
associated with obesity and aging.
The study wasn't a controlled experiment designed to prove whether
or how issues with medication access and affordability might
directly impact health outcomes for people with diabetes.
Still, it provides fresh evidence of the need to improve global
access to diabetes medicines, particularly with insulin, said
Alessandra Ferrario, author of an accompanying editorial and a
researcher at Harvard Pilgrim Health Care Institute and Harvard
Medical School in Boston.
"Poor treatment of diabetes can lead to increased (complications)
and mortality, hence poor access contributes to increased burden of
disease," Ferrario said by email.
"Medicines are a key component in the treatment of diabetes,
however, patients also need to be diagnosed on time, and
under-diagnosis is common in developing countries," Ferrario added.
"And medicines are not the only cost for diabetes patients,"
Ferrario noted. "Glucose monitoring and visits to the doctor should
also be taken into account when analyzing the financial burden of
diabetes treatment for patients."
SOURCE: http://bit.ly/2O0PuJV Lancet Diabetes & Endocrinology,
online August 28, 2018.
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