Insulin prices, availability and affordability in 13 low-income and middle-income countries
Insulin prices, availability and affordability in 13 low-income and middle-income countries
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DOI：
10.1136/bmjgh-2019-001410
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发表时间：
2019-05-01
影响因子：
8.1
通讯作者：
Laing, Richard
中科院分区：
文献类型：
--
作者：
Ewen, Margaret;Joosse, Huibert-Jan;Laing, Richard
在全球范围内，每两个需要胰岛素的人中就有一个无法获得胰岛素。高价格和低可用性被认为是导致胰岛素可及性差的关键因素。然而，很少有研究以系统的方式评估低收入和中等收入国家不同胰岛素类型的可用性、价格和可负担性。方法2016年，进行了15项胰岛素价格和可用性调查（采用经改编的世卫组织/国际卫生行动组织药品价格和供应计量方法），巴西、中国（湖北省和陕西省）、埃塞俄比亚、加纳、印度（哈里亚纳邦和中央邦）、印度尼西亚、约旦、肯尼亚、吉尔吉斯斯坦、马里、巴基斯坦、俄罗斯（喀山省）和乌干达。每次调查在三个地区的三个部门（公共、私人药房和私人医院/诊所）收集数据。胰岛素价格标准化为10 mL 100 IU/mL（美元）。四个比较medicine.Results平均可用性较高的人（55%-80%）与类似物胰岛素（55%-63%），但只有短效人胰岛素达到80%的可用性（公共部门）。政府采购价格中位数为5美元（人胰岛素）和33美元（长效类似物）。在这三个领域中，人胰岛素的患者价格中位数为9美元。类似物的中位患者价格在公共部门（34美元）和两个私营部门（44美元）之间存在差异。小瓶比钢笔和墨盒便宜。生物仿制药在可用时，大多比原研药便宜。低收入者分别需要工作4天和7天才能购买10 mL人胰岛素和类似物胰岛素。对于低精蛋白人胰岛素，只有三个国家达到了WHO的目标，即在任何部门都能提供80%的可负担得起的非传染性疾病基本药物。结论需要通过国家和全球行动来提高胰岛素的可获得性和可负担性，包括优先供应更可负担得起的人胰岛素，通过使用价格更低、质量有保证的生物仿制药来增加竞争，与制造商谈判降低价格并改善分销系统。
Introduction Globally, one in two people needing insulin lack access. High prices and poor availability are thought to be key contributors to poor insulin access. However, few studies have assessed the availability, price and affordability of different insulin types in low-income and middle-income countries in a systematic way.Methods In 2016, 15 insulin price and availability surveys were undertaken (using an adaptation of the WHO/Health Action International medicine price and availability measurement methodology) in Brazil, China (Hubei and Shaanxi Provinces), Ethiopia, Ghana, India (Haryana and Madhya Pradesh States), Indonesia, Jordan, Kenya, Kyrgyzstan, Mali, Pakistan, Russia (Kazan Province) and Uganda. Data were collected in three sectors (public, private pharmacies and private hospitals/clinics) in three regions per survey. Insulin prices were standardised to 10 mL 100 IU/mL in US dollars ($). Data were also collected for four comparator medicines.Results Mean availability was higher for human (55%-80%) versus analogue insulins (55%-63%), but only short-acting human insulin reached 80% availability (public sector). Median government procurement prices were $ 5 (human insulins) and $ 33 (long-acting analogues). In all three sectors, median patient prices were $ 9 for human insulins. Median patient prices for analogues varied between the public sector ($34) and the two private sectors ($44). Vials were cheaper than pens and cartridges. Biosimilars, when available, were mostly cheaper than originators. A low-income person had to work 4 and 7 days to buy 10 mL human and analogue insulin, respectively. For isophane human insulin, only three countries meet the WHO target of 80% availability of affordable essential medicines for non-communicable diseases in any sector.Conclusion Improving insulin availability and affordability needs to be addressed through national and global actions, including prioritising the supply of more affordable human insulin, increasing competition through the use of lower priced quality-assured biosimilars, negotiating lower prices from manufacturers and improving distribution systems.