Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study
Lancet Diabetes Endocrinol. (Online)
; 6(10): 798-808, Oct. 2018. tab, graf
Article
in English
| Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1179346
Responsible library:
BR79.1
Localization: br79.1
ABSTRACT
BACKGROUND:
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.METHODS:
In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 3570 years (n=156625) were recruited from 110803 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.FINDINGS:
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.
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Collection:
National databases
/
Brazil
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 5: Medicines, vaccines and health technologies
Database:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Metformin
Type of study:
Prognostic study
/
Risk factors
Aspects:
Social determinants of health
Language:
English
Journal:
Lancet Diabetes Endocrinol. (Online)
Year:
2018
Document type:
Article
Institution/Affiliation country:
College of Health Sciences, Physiology Department, University of Zimbabwe/ZW
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Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University/SA
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Department of Community Health Sciences and Medicine, Aga Khan University/PK
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Department of Community Health, University Kebangsaan Malaysia Medical Centre/MY
/
Department of Community Medicine, Amrita Institute of Medical Sciences/IN
/
Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital/TR
/
Department of Medicine, Queen's University/CA
/
Department of Medicine, Universidad de La Frontera, Francisco Salazar/CL
/
Department of Medicine, Universiti Teknologi MARA/MY
/
Department of Medicine, University of the Philippines/PH