Abstract
Background: Diabetes imposes an enormous burden on patients, families, societies, and healthcare systems. Determining the affordability of medications is an important complicated and vague task, especially in low- and middle-income countries (LMICs). This study aimed to assess the affordability of diabetes medication therapy in Iran’s health system. Methods: This paper presents a scenario-based assessment of the affordability of all registered anti-diabetes medications in Iran in 2017. To this end, 4 medication therapy scenarios were defined as mono, dual, triple, and insulin therapy in accordance with the existing guidelines and clinicians’ opinions. Then the affordability ratio of each treatment scenario was determined for type 1 and type 2 diabetes drawing on the World Health Organization (WHO)/Health Action International (HAI) Methodology. If the affordability ratio for treatment schedules was more than 1, the patients’ out-of-pocket (OOP) expenses exceeded the lowest-paid unskilled government worker (LPGW)’ wage per day, and the treatment was labelled as non-affordable. Results: The results revealed that the mono, dual, and triple (non-insulin) medication therapies in type 2 diabetes were affordable, despite an increase in the dosage or a switch from the monotherapy to the combination therapy of oral medications. However, some treatment scenarios in the triple therapy, including oral plus insulin and some insulin only therapies, were proved to be non-affordable. In type 1 diabetes, only insulin glulisine, detemir, and lispro were non-affordable in monotherapy. Regarding the combination therapy, only isophane insulin with aspart or regular insulin were affordable treatments. Conclusion: Although oral medication therapies were documented to be affordable, insulin therapy, with current coverage conditions, for patients with lowest paid wages and those receiving even less is unaffordable and a major barrier to treatment; hence, policy-maker should consider targeting and more financial protection policies to improve the affordability of insulin therapies among this group of patients.
Highlights
According to the World Health Organization (WHO) Guidelines on Country Pharmaceutical Pricing Policies, healthcare decision-makers should find appropriate solutions to manage medicine prices, their availability, and affordability in low- and middle-income countries (LMICs).[1]
Implications for the public Medication affordability takes on added significance in the case of diabetes, as a chronic non-communicable disease (NCD), because the medicines for their treatment should often be taken for a long time and even lifetime in some cases
Medication affordability takes on added significance in the case of non-communicable diseases (NCDs) as the medicines for their treatment should often be taken for a long time and even lifetime in some cases.[5]
Summary
According to the World Health Organization (WHO) Guidelines on Country Pharmaceutical Pricing Policies, healthcare decision-makers should find appropriate solutions to manage medicine prices, their availability, and affordability in low- and middle-income countries (LMICs).[1] Undoubtedly, medication affordability has always been considered as a formidable challenge in healthcare decisions and debates.[2] On the other hand, medication is the largest household expenditure item, following food expenditures, in developing countries.[3] Twenty to 60% of health expenditure in LMICs accounts for medications, which is a significant proportion,[3] and 90% of individuals living in developing countries have to buy their medicines out-of-pocket (OOP).[4] It has been reported that more than one-third of the global population cannot afford their necessary medicines[4]; policymakers in LMICs have to address questions about the OOP payments for healthcare services and medications.[2] Medication affordability takes on added significance in the case of non-communicable diseases (NCDs) as the medicines for their treatment should often be taken for a long time and even lifetime in some cases.[5]
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