Costs of insulin in developing countries
There are only 3 companies that control 99% of the global market by value. This lack of competition causes the price for insulin to continuously rise despite many insulin products being off-patents.
There are approximately 100 million people who need insulin around the world. Of these, one in two cannot reliably access this life-saving medication because it is unavailable, unaffordable, or both.
Fifty-five percent of countries reported charging a tax on insulin. The average tax was 13% with Mongolia charging the highest rate at 30%.
A lack of insulin is the number one cause of death for children living with type 1 diabetes.
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The average Type 1 diabetic in India spends more than 25 percent of their income on their health. India is struggling to provide medical access because it has the second fastest growth of diabetes and 70% of the population lives in rural villages.
"Poor healthcare is one of the greatest causes of poverty. For an individual earning less than $2 a day, this presents significant challenges from taking time off work to taking out loans for medical care in places like India where over 70% of the population lives without insurance. The average up-front cost to monitoring is roughly 4000 rps, or $80, with additional 1000 rps ($20) cost for every 50 strip bottle purchased."
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The governments in Mali, Mozambique and Zambia spend $28, $14, and $36 per person, per year respectively on health expenditures. The average buyer price for insulin on the International Drug Price Indicator is $80.21 for 13 vials, which is equivalent to 2.9, 5.7 and 2.2 times the entire health expenditures per person for those respective countries.
In Nicaragua, the government spends $90 per person, per year on insulin. This is a high burden on a country with a per capita GDP of only $4,223.
http://apps.who.int/medicinedocs/documents/s18773en/s18773en.pdf
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In Mali, where the per capita GDP = $900, for a city dweller the cost for diabetes care = $225 a year, of which $132 is for the cost of insulin.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822152
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Taxed as a luxury item in most Central American countries, insulin is a precious commodity, says Stabler, whose IFL all-volunteer board purchases Actrapid and Insulatard insulin from Novo Nordisk of Denmark at less than $5 a bottle. The organization then ships the insulin to doctors in Guatemala, the Red Cross of Nicaragua, and the Diabetes Association of El Salvador. “A vial of these insulins in Central America would cost about $15, which is equivalent to one week’s salary for the average worker in most Central American countries." Decades of civil war and violence have destroyed the infrastructure of these countries and left hospitals. Note: Insulin For Life (IFL), is a non-profit organization headquartered in San Francisco.
Russia: Regular and NPH insulins made by Eli Lilly and Novo Nordisk cost around $25 per vial. Humalog, if available, costs $30 per vial. The average monthly salary in Moscow ranges from $50 to $100.
In Brazil the minimum wage comes to about $70 per month. A bottle of Humalog insulin can cost up to $35. According to Rosangela Rea, a Brazilian doctor, a vial of insulin costs about 20 percent of the average worker’s income in Brazil. Ms Rea says: “I estimate that only seven-to-nine percent of Brazil’s insulin-dependent diabetics are treated with insulin”.
Philippines: NPH insulin is available in 40 and 80-units, which costs about $18. On top of that the Philippines taxes insulin anywhere between 10 and 20 percent. The average worker’s income is roughly $100 to $200 per month. About 50 percent of all insulin is donated from private individuals. The other 50 percent comes from Eli Lilly and Novo Nordisk of which usually have passed their expiration dates by about one year, but are still potent.
Sub-Sahara Africa: The average worker’s income in a lot of African countries is $160 to $200 per month says Arthur Teuscher, MD, of the Nutrition and Diabetes Foundation (NDF). The NDF has developed a cost-sharing program to buy on the international market, in which the patient pays 50 percent, while the NDF pays the rest. As a result of the program, some diabetic patients pay only $1.25 for a 400-unit bottle of insulin. Africans who do not have access to the cost-sharing project spend upwards to $10 for a 400-unit bottle insulin that is manufactured by Eli Lilly or Novo Nordisk. This comes to approximately $300 per year. Mr. Teuscher says: Most Africans with diabetes who cannot afford insulin try to get along with smaller insulin doses and most of them do not survive. According to the WHO, in some parts of Africa the mortality from insulin-dependent diabetes is estimated at 50 percent in the first five years of the illness.
India: $4.50 for month supply of 40-unit Beef insulin. $9.60 for month supply of 40-unit Pork insulin. $15.00 for month supply of 40-unit Human insulin. The average Indian family earns an income of only $28 per month. Despite this, the World Health Organization has recommended the universal use of U-100 human insulins, and Eli Lilly has removed the cheaper animal insulins from most world markets.
According to the World Health Organization (WHO), economics is the major barrier to insulin access in most countries. Lack of transportation, distance from urban areas where distribution takes place, and lack of electricity and refrigeration for insulin storage are other inhibiting factors.
https://www.diabeteshealth.com/insulin-outside-america/
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