Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study

医学 流行病学 二甲双胍 药店 糖尿病 审计 环境卫生 格列本脲 家庭医学 业务 内科学 会计 内分泌学
作者
Clara K Chow,Chinthanie Ramasundarahettige,Weihong Hu,Khalid F. AlHabib,Álvaro Avezum,Xiaoru Cheng,Jephat Chifamba,Gilles R. Dagenais,Antonio Dans,Bonaventure Amandi Egbujie,Rajeev Gupta,Romaina Iqbal,Noor Hassim Ismail,Miraç Vural Keskinler,Rasha Khatib,Iolanthé M. Kruger,Rajesh Kumar,Fernando Laņas,Scott A. Lear,Patricio López‐Jaramillo,Martin McKee,Noushin Mohammadifard,Viswanathan Mohan,Prem Mony,Andrés Orlandini,Annika Rosengren,Krishnapillai Vijayakumar,Wei Li,Karen Yeates,Khalid Yusoff,Rita Yusuf,Afzalhussein Yusufali,Katarzyna Zatońska,Yihong Zhou,Sheikh Mohammed Shariful Islam,Daniel J. Corsi,Sumathy Rangarajan,Koon Teo,Hertzel C. Gerstein,Salim Yusuf
出处
期刊:The Lancet Diabetes & Endocrinology [Elsevier]
卷期号:6 (10): 798-808 被引量:158
标识
DOI:10.1016/s2213-8587(18)30233-x
摘要

Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use.In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35-70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys.Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines.Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes.Full funding sources listed at the end of the paper (see Acknowledgments).
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