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. 2014 Oct 16;4(10):e005859.
doi: 10.1136/bmjopen-2014-005859.

Low utilisation of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study

Amir Sarayani  1 , Arash Rashidian  2   3 , Kheirollah Gholami  4
Affiliations

Low utilisation of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study

Amir Sarayani et al. BMJ Open. .

Abstract

Objectives: Diabetes is a major public health concern worldwide, particularly in low-income and middle-income countries (LMICs). Limited data exist on the status of access to diabetes medicines in LMICs. We assessed the utilisation and affordability of diabetes medicines in Iran as a middle-income country.

Design: We used a retrospective time-series design (2000-2012) and assessed national diabetes medicines' utilisation using pharmaceuticals wholesale data.

Methods: We calculated defined daily dose consumptions per population days (DDDs/1000 inhabitants/day; DIDs) indicator. Findings were benchmarked with data from Organization for Economic Co-operation and Development (OECD) countries. We also employed Drug Utilization-90% (DU-90) method to compare DU-90s with the Essential Medicines List published by the WHO. We measured affordability using number of minimum daily wage required to purchase a treatment course for 1 month.

Results: Diabetes medicines' consumption increased from 4.47 to 33.54 DIDs. The benchmarking showed that medicines' utilisation in Iran in 2011 was only 54% of the median DIDs of 22 OECD countries. Oral hypoglycaemic agents consisted over 80% of use throughout the study period. Regular and isophane insulin (NPH), glibenclamide, metformin and gliclazide were the DU-90 drugs in 2012. Metformin, glibenclamide and regular/NPH insulin combination therapy were affordable throughout the study period (∼0.4, ∼0.1, ∼0.3 of minimum daily wage, respectively). While the affordability of novel insulin preparations improved over time, they were still unaffordable in 2012.

Conclusions: The utilisation of diabetes medicines was relatively low, perhaps due to underdiagnosis and inadequate management of patients with diabetes. This had occurred despite affordability of essential diabetes medicines in Iran. Appropriate policies are required to address the underutilisation of diabetes medicines in Iran.

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Figures

Figure 1
Figure 1
Utilisation pattern of diabetes medicines (A10) in Iran (DDD, defined daily dose).
Figure 2
Figure 2
Pattern of Drug Utilization-90% for diabetes medicines in Iran.
Figure 3
Figure 3
Benchmarking diabetes drugs utilisation in Iran with OECD countries (2011) (DDD, defined daily dose; OECD, Organization for Economic Co-operation and Development).
Figure 4
Figure 4
Benchmarking the trend of diabetes drugs utilisation (Iran and OECD countries with comparable diabetes prevalence according to IDF statistics). DDD, defined daily dose; IDF, International Diabetes Federation; OECD, Organization for Economic Co-operation and Development.
Figure 5
Figure 5
Affordability of oral hypoglycaemic agents in Iran.
Figure 6
Figure 6
Affordability of insulin preparations in Iran.
See this image and copyright information in PMC

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