Repositorio
Institucional

Chow, Clara K.

Ramasundarahettige, Chinthanie#Hu, Weihong#AlHabib, Khalid F.#Avezum, Alvaro, Jr.#Cheng, Xiaoru#Chifamba, Jephat#Dagenais, Gilles#Dans, Antonio#Egbujie, Bonaventure A.#Gupta, Rajeev#Iqbal, Romaina#Ismail, Noorhassim#Keskinler, Mirac V.#Khatib, Rasha#Kruger, Lanthe#Kumar, Rajesh#Lanas, Fernando#Lear, Scott#Lopez-Jaramillo, Patricio#McKee, Martin#Mohammadifard, Noushin#Mohan, Viswanathan#Mony, Prem#Orlandini, Andres#Rosengren, Annika#Vijayakumar, Krishnapillai#Wei, Li#Yeates, Karen#Yusoff, Khalid#Yusuf, Rita#Yusufali, Afzalhussein#Zatonska, Katarzyna#Zhou, Yihong#Islam, Shariful#Corsi, Daniel#Rangarajan, Sumathy#Teo, Koon#Gerstein, Hertzel C.#Yusuf, Salim

Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study

ELSEVIER SCIENCE INC

LANCET DIABETES & ENDOCRINOLOGY

en

Background Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. Methods In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35-70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries, availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. Findings Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88.2%) of 127 pharmacies in upper-middle-income countries, 179 (86.1%) of 208 pharmacies in lower-middle-income countries, 44 (64.7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93.8%) pharmacies in high-income countries, 51 (40.2%) pharmacies in upper-middle-income countries, 61 (29.3%) pharmacies in lower-middle-income countries, seven (10.3%) pharmacies in lower-income countries, and 67 (76.1%) of 88 pharmacies in India. We estimated 0.7% of households in high-income countries and 26.9% of households in low-income countries could not afford metformin and 2.8% of households in high-income countries and 63.0% of households in low-income countries could not afford insulin. Among the 13 569 (8.6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74.0%) participants reported diabetes medicine use in high-income countries compared with 143 (29.6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines. Interpretation Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes. Copyright (c) 2018 Elsevier Ltd. All rights reserved.

Artículo original

Funding and support: CKC is supported by a National Health and Medical Research Council Career Development Fellowship Level 2 cofunded by the National Heart Foundation. SY is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE study is an investigator-initiated study that is funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Support from Canadian Institutes of Health Research's Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies [with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline], and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries. These include: Argentina: Fundacion Estudios Clinicos Latino America, Bangladesh: Independent University, Bangladesh and Mitra and Associates, Brazil: Unilever Health Institute, Brazil, Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias (grant number: 6566-04-18062), India: Indian Council of Medical Research, Malaysia: Ministry of Science, Technology and Innovation of Malaysia (grant number: 100-IRDC/BIOTEK 16/6/21 [13/2007], and 07-05-IFN-BPH 010), Ministry of Higher Education of Malaysia (grant number: 600-RMI/LRGS/5/3 [2/2011]), UniversitiTeknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory, International Development Research Centre, Canada, Philippines: Philippine Council for Health Research and Development, Poland: Polish Ministry of Science and Higher Education (grant number: 290/W-PURE/2008/0), Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number: RG-1436-013), South Africa: The North-West University, SA and Netherlands Programme for Alternative Development, National Research Foundation, Medical Research Council of South Africa, The South Africa Sugar Association, Faculty of Community and Health Sciences, Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors, the Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare, King Gustaf V and Queen Victoria Freemasons Foundation, AFA Insurance, Turkey: Metabolic Syndrome Society, AstraZeneca, Sanofi Aventis, United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai.

Financiación y apoyo: CKC cuenta con el apoyo de una Beca de Desarrollo Profesional Nivel 2 del Consejo Nacional de Investigación Médica y de Salud, cofinanciada por la Fundación Nacional del Corazón. SY cuenta con el apoyo de la cátedra Mary W. Burke de la Fundación del Corazón y el Accidente Cerebrovascular de Ontario. El estudio PURE es un estudio iniciado por investigadores y financiado por el Instituto de Investigación en Salud Poblacional, los Institutos Canadienses de Investigación en Salud, la Fundación del Corazón y el Accidente Cerebrovascular de Ontario, con el apoyo de la Estrategia para la Investigación Orientada al Paciente de los Institutos Canadienses de Investigación en Salud, a través de la Unidad de Apoyo SPOR de Ontario, así como del Ministerio de Salud y Cuidados a Largo Plazo de Ontario y mediante subvenciones sin restricciones de varias compañías farmacéuticas [con importantes contribuciones de AstraZeneca (Canadá), Sanofi-Aventis (Francia y Canadá), Boehringer Ingelheim (Alemania y Canadá), Servier y GlaxoSmithKline], y contribuciones adicionales de Novartis y King Pharma, y ​​de varias organizaciones nacionales o locales en los países participantes. Estos incluyen: Argentina: Fundación Estudios Clínicos Latinoamérica, Bangladesh: Independent University, Bangladesh y Mitra and Associates, Brasil: Unilever Health Institute, Brasil, Canadá: Public Health Agency of Canada y Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias (número de subvención: 6566-04-18062), India: Indian Council of Medical Research, Malasia: Ministry of Science, Technology and Innovation of Malaysia (número de subvención: 100-IRDC/BIOTEK 16/6/21 [13/2007] y 07-05-IFN-BPH 010), Ministry of Higher Education of Malaysia (número de subvención: 600-RMI/LRGS/5/3 [2/2011]), UniversitiTeknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), territorio palestino ocupado: Estados Unidos Organismo de Obras Públicas y Socorro de las Naciones Unidas para los Refugiados de Palestina en el Cercano Oriente, territorio palestino ocupado, Centro Internacional de Investigaciones para el Desarrollo, Canadá, Filipinas: Consejo Filipino para la Investigación y el Desarrollo en Salud, Polonia: Ministerio de Ciencia y Educación Superior de Polonia (número de subvención: 290/W-PURE/2008/0), Universidad Médica de Wroclaw, Arabia Saudita: Asociación Saudí del Corazón, Decanato de Investigación Científica de la Universidad Rey Saud, Riad, Arabia Saudita (número de grupo de investigación: RG-1436-013), Sudáfrica: Universidad del Noroeste, Programa de Sudáfrica y Países Bajos para el Desarrollo Alternativo, Fundación Nacional de Investigación, Consejo de Investigación Médica de Sudáfrica, Asociación Sudafricana del Azúcar, Facultad de Ciencias de la Comunidad y la Salud, Suecia: subvenciones del estado sueco en virtud del Acuerdo sobre investigación y educación de médicos, Fundación Sueca del Corazón y los Pulmones, Consejo Sueco de Investigación, Consejo Sueco para la Salud, la Vida Laboral y el Bienestar, Fundación de los Francmasones Rey Gustavo V y Reina Victoria, AFA Insurance, Turquía: Sociedad del Síndrome Metabólico, AstraZeneca, Sanofi Aventis, Emiratos Árabes Unidos: Premio Sheikh Hamdan Bin Rashid Al Maktoum de Ciencias Médicas y Autoridad Sanitaria de Dubái, Dubái.

10.1016/S2213-8587(18)30233-X

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http://dx.doi.org/10.1016/S2213-8587(18)30233-X

Endocrinology & Metabolism

Endocrinología y Metabolismo (Incluye Diabetes, Hormonas)

Política de Salud y Servicios

Salud Pública y Ambiental

WOS:000445538600022

Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study

Artículo original

version publicada

ELSEVIER SCIENCE INC

LANCET DIABETES & ENDOCRINOLOGY

Endocrinología y Metabolismo

2213-8587

en

National Health and Medical Research Council Career Development Fellowship Level 2#National Heart Foundation##Heart and Stroke#Population Health Research Institute#Canadian Institutes of Health Research#Heart and Stroke#Ontario Ministry of Health and Long-Term Care#AstraZeneca (Canada)#Sanofi-Aventis (France and Canada)#Boehringer Ingelheim (Germany and Canada)#Servier#GlaxoSmithKline#Novartis and King Pharma#Fundacion Estudios Clinicos Latino America#Independent University#Bangladesh and Mitra and Associates#Unilever Health Institute, Brazil#Public Health Agency of Canada#Champlain Cardiovascular Disease Prevention Network#UFRO#National Center for Cardiovascular Diseases#Colciencias 6566-04-18062#Indian Council of Medical Research#Ministry of Science, Technology and Innovation of Malaysia 100-IRDC/BIOTEK 16/6/21 [13/2007]#Ministry of Science, Technology and Innovation of Malaysia 07-05-IFN-BPH 010#Ministry of Higher Education of Malaysia 600-RMI/LRGS/5/3 [2/2011]# UniversitiTeknologi MARA#Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010)#United Nations Relief and Works Agency for Palestine Refugees in the Near East#International Development Research Centre, Canada#Philippine Council for Health Research and Development#Polish Ministry of Science and Higher Education 290/W-PURE/2008/0#Wroclaw Medical University#Saudi Heart Association#The Deanship of Scientific Research at King Saud University, Riyadh RG-1436-013#The North-West University#National Research Foundation#Medical Research Council of South Africa#The South Africa Sugar Association#Faculty of Community and Health Sciences#Swedish state #Swedish Heart and Lung Foundation#Swedish Research Council#Swedish Council for Health, Working Life and Welfare#King Gustaf V and Queen Victoria Freemasons Foundation#AFA Insurance#Metabolic Syndrome Society#AstraZeneca#Sanofi Aventis#Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences#Dubai Health Authority

Funding and support: CKC is supported by a National Health and Medical Research Council Career Development Fellowship Level 2 cofunded by the National Heart Foundation. SY is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE study is an investigator-initiated study that is funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Support from Canadian Institutes of Health Research's Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies [with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline], and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries. These include: Argentina: Fundacion Estudios Clinicos Latino America, Bangladesh: Independent University, Bangladesh and Mitra and Associates, Brazil: Unilever Health Institute, Brazil, Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias (grant number: 6566-04-18062), India: Indian Council of Medical Research, Malaysia: Ministry of Science, Technology and Innovation of Malaysia (grant number: 100-IRDC/BIOTEK 16/6/21 [13/2007], and 07-05-IFN-BPH 010), Ministry of Higher Education of Malaysia (grant number: 600-RMI/LRGS/5/3 [2/2011]), UniversitiTeknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory, International Development Research Centre, Canada, Philippines: Philippine Council for Health Research and Development, Poland: Polish Ministry of Science and Higher Education (grant number: 290/W-PURE/2008/0), Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number: RG-1436-013), South Africa: The North-West University, SA and Netherlands Programme for Alternative Development, National Research Foundation, Medical Research Council of South Africa, The South Africa Sugar Association, Faculty of Community and Health Sciences, Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors, the Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare, King Gustaf V and Queen Victoria Freemasons Foundation, AFA Insurance, Turkey: Metabolic Syndrome Society, AstraZeneca, Sanofi Aventis, United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai.

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