Insulin prices, availability and affordability in 13 low-income and middle-income countries

Abstract

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.

Keywords: affordability; availability; diabetes; insulin; low- and middle-income countries; prices.

Figure 1

Median prices of insulin by category and sector, 10 mL 100 IU/mL in US dollars (any presentation).

Figure 2

Affordability and availability, isophane (intermediate acting) human insulin, per country and sector. Availability: 0% in public sector in IH, IP, ID and KE, 0% in private pharmacies KE and IP and 0% in private hospitals in IP. BR, Brazil; CB, Hubei, China; CS, Shaanxi, China; DW, days’ wages; ET Ethiopia; GH, Ghana; ID, Indonesia; IH, Haryana, India; IP, Madhya Pradesh, India; JO, Jordan; KE, Kenya; KG, Kyrgyzstan; ML, Mali; PK, Pakistan; RU, Kazan, Russia; UG, Uganda.