medwireNews: Diabetes medications are frequently unavailable and unaffordable, particularly in lower-income countries, shows an analysis of the PURE study.
Moreover, availability and affordability correlated with use of metformin, sulfonylureas, and insulin, suggesting these factors are “a substantial driver of lower use of these medicines,” say Clara Chow (University of Sydney, New South Wales, Australia) and co-researchers.
“Although several countries have programmes to provide subsidised medicines, the data presented here show universal access is still a distant prospect and that government and industry really are not doing enough to ensure the availability and affordability of these essential medicines to people that need them,” they write.
Metformin was the most widely available medication studied, being available in all 113 community pharmacies surveyed in four high-income countries, and in 88.2% and 86.1% of a corresponding 127 and 208 pharmacies in eight upper-middle and five lower-middle income countries.
However, it was only available in 64.7% of 68 pharmacies in four low-income countries, the researchers report in The Lancet Diabetes & Endocrinology.
These four low-income countries excluded India, which although classed in this category was previously found to have markedly different medication availability, in part because of the size of its domestic pharmaceutical industry. Indeed, metformin was available in all 88 Indian pharmacies surveyed.
The PURE study included 156,625 people aged 35–70 years from 110,803 households in 22 countries, 8.7% of whom reported a diagnosis of diabetes.
Medication availability became a larger problem for patients needing more than metformin, with glibenclamide and gliclazide only available in 75.2–84.1% of pharmacies even in high-income countries. In lower-income countries, availability of these sulfonylureas ranged from 31.7% for gliclazide in lower-middle income countries to 71.7% for gliclazide in upper-middle income countries. They were also available in around 70–80% of Indian pharmacies.
The situation was worse again for patients dependent on insulin, which was available in 93.8% of pharmacies in high-income countries and 76.1% of Indian pharmacies, but only in 10.3% to 40.2% of pharmacies in other countries.
Regardless of availability, the researchers found that a significant proportion of households would struggle to afford a monthly supply of diabetes medications, defined as it costing at least 20% of their available money after accounting for food expenditure.
Even metformin, the cheapest medication, would be beyond the means of 0.7% of households in high-income countries, rising to 26.9% of those in low-income countries. The corresponding rates for insulin were 2.8% and 63.0%. In contrast to medication availability, affordability in India was broadly in line with that of other low-income countries.
There was also a gradient of medication use, such that rates were markedly higher among study participants in high-income than low-income countries, at 74.0% versus 29.6%. This correlated significantly with medication availability after accounting for variables including economic region. Affordability was associated with use of oral medication, but not insulin, after adjustment for confounders.
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