Insulin access remains limited for thousands of people, study finds
The study - which is a collaboration between Health Action International in the Netherlands, Boston University's School of Public health, and the Geneva University Hospitals and University of Geneva, Switzerland - found that in many lower-income countries, insulin is prohibitively expensive, despite being listed as an essential medicine by the World Health Organisation (WHO) since 2007.
The review found that one of the most significant factors behind the rise in insulin prices is the dominance of three large, multinational companies in the market. Because of this, competition is limited, and it's competition that is largely responsible for driving down prices. The researchers found that insulin access can be a problem both in affluent parts of the USA, where it can cost $400 a month, and in the poorest parts of the world. In parts of Africa, a child born with type 1 diabetes has a life expectancy of just one year.
"Insulin access is a complex challenge," explains author Dr. David Beran from the Geneva University Hospitals and University of Geneva in Switzerland. "A wide variety of issues affect access including the global insulin market being dominated by three multinational manufacturers; import duties and taxes affecting the price insulin is entering different countries; and mark-ups in the public and private sectors that also make insulin expensive."
Another problem highlighted by the review is the growing prevalence of synthetic analogue insulin instead of human insulin, despite a WHO report that found that the more expensive analogue insulin is no more effective than human insulin in less economically developed countries. In economically developed countries, where people can expect to have good control of their diabetes, analogue insulin does tend to be more effective than human insulin, particularly for people with type 1 diabetes. Analogue insulin is associated with fewer hypoglycemic episodes, particularly overnight.
In less affluent countries, however, the difference between human and analogue insulin is less of an issue, particularly when analogue insulin is usually far more expensive than most people can afford. According to Beran: "We have seen a trend in the insulin market with animal insulin disappearing and being replaced by human insulin. A concern is whether a similar trend in which human insulin is replaced by analogue will occur."
The end result is that insulin is becoming more expensive for health systems. This, combined with the increasing number of people using insulin - which trebled between 1991 and 2010 - has led to problems with insulin access worldwide. On the NHS, spending on analogue insulin rose from £18.2m in 2000 to £305m in 2010. Much of this, however, is due to the significant increase in the prescription of Lantus, an analogue basal insulin, for people with type 2 diabetes.
Dr. Beran argues that improving the situation will require tailored solutions for different countries:
"Addressing the challenges and constraints of insulin supply will require interventions to be tailored to individual countries. Some lower-income countries, like Nicaragua, are doing very well at providing insulin for free for its population, while other countries, such as Mali are charging high prices for it even in the public sector."
Co-author Margaret Ewen, from Health Action International in Amsterdam, hopes that this study will drive awareness of the issue:
"The issue of access to insulin lacks a global voice and global mobilisation of resources. Over the past three decades, HIV/AIDS has attracted global attention with civil society truly getting behind the issue of universal access to antiretrovirals. The lessons from the successful treatment of HIV/AIDS need to be applied to ensure universal access to insulin."
The findings are published in The Lancet Diabetes and Endocrinology.
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