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. 2021 Sep:179:108996.
doi: 10.1016/j.diabres.2021.108996. Epub 2021 Aug 4.

Costs and underuse of insulin and diabetes supplies: Findings from the 2020 T1International cross-sectional web-based survey

Elizabeth Pfiester  1 , Katarina Braune  2 , Axel Thieffry  3 , Hanne Ballhausen  4 , Katarzyna Anna Gajewska  5 , Shane O'Donnell  6
Affiliations
Free article

Costs and underuse of insulin and diabetes supplies: Findings from the 2020 T1International cross-sectional web-based survey

Elizabeth Pfiester et al. Diabetes Res Clin Pract. 2021 Sep.
Free article

Abstract

Aims: To investigate self-reported out-of-pocket expenses (OoPE) associated with insulin and diabetes supplies for people living with type 1 diabetes (T1D) worldwide.

Methods: A web-based, cross-sectional survey was conducted from August to December 2020. The analysis included comparisons between responses from countries with no, partial, and full healthcare coverage.

Results: 1,066 participants from 64 countries took part in the study. ~25% of respondents reported having underused insulin at least once within the last year due to perceived cost. A significant correlation was observed between OoPEs and reported household income for respondents with partial healthcare coverage. 63.2% of participants reported disruption of insulin supplies and 25.3% reported an increase of prices related to the COVID-19 pandemic.

Conclusions: This study confirms previous reports of ~25% of people in the United States with T1D using less insulin and/or fewer supplies at least once in the last year due to cost, a trend associated with the extent of healthcare coverage. Similar trends were observed in some middle/low income countries. Moreover, patients reported an increase in insulin prices and disruption of supplies during the COVID-19 pandemic. This study highlights the importance of self-reported OoPEs and its association with underuse/rationing of insulin.

Keywords: Costs; Insulin; Out-of-pocket expenses; Rationing; Type 1 diabetes; Underuse.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EP is employed as Executive Director of T1International. KB received funding from the European Commission Horizon 2020 program, the DFG-funded Berlin Institute of Health (BIH) Digital Clinician Scientist program, the BIH Junior Clinician Scientist program, the BIH QUEST center, the German Diabetes Association (DDG) and Wellcome Trust; and fees for medical consulting and public speaking from Roche Diabetes Care, Dexcom, Medtronic Diabetes, Diabeloop, Sanofi Diabetes, BCG Digital Ventures and Novo Nordisk; all outside the submitted work. AT analyzed the data in quality of consultant for T1International. KG received fees for public speaking from Novo Nordisk and is an employee of Diabetes Ireland, an organization cooperating with companies producing insulin and supplies. All other authors declare no conflict of interest.

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