Background: The prevalence of diabetes in developing countries is rapidly increasing due to urbanisation and lifestyle change. For diabetes patients it is essential to have regular access to their treatment to prevent complications or death. Type 1 diabetes patients require insulin therapy and type 2 diabetes patients need treatment with oral hypoglycaemic agents or insulin. Diabetes mellitus is a chronic condition and treatment costs are therefore an important factor for patients.

Objectives: General: Characterisation of the costs and availability of diabetes medicines, syringes and monitoring tools for patients by country, WHO region and economic status in developing and middle income countries. Specific:

1. Description of all available data on costs and availability of diabetes treatment and the strengths and weaknesses of the methodologies used.
2. Comparison and analysis of cost and consumption data by region and economic status.
3. Identify and investigate taxes, duties and mark-ups in the public sector.
4. Present conclusions based on analysis.

Methodology: Data from the International Diabetes Federation, International Insulin Foundation, WITS database, World Health Organization/Health Action International and IMS-Health were used for this report.

Results: High costs in the private sector and low availability in the public sector were the largest barriers for poor access to insulin and supplies. Taxes were charged on insulin in some countries. In 40 countries, import tariffs were levied. However, the number of countries charging tariffs has decreased since 2005. The public sector procurement price of metformin 500 mg and glibenclamide 5 mg were low in most countries. In low-income countries, some high mark-ups were charged. This could be due to government procedures or as a result of public facilities buying medicines in the private sector. In low-income countries, the affordability of the lowest priced generic in the public and private sector was similar. However, in several countries, diabetes medicines were provided free of charge for people with diabetes or for particular group. The availability was often poor in those countries. In most countries, the availability of the medicines was higher in the private sector than in the public sector and the availability of glibenclamide was higher than the availability of metformin. In 2007, metformin and glimepiride were the most consumed oral diabetes medicines in 49 IMS surveyed countries. Over the last six years the consumption of these two medicines has increased substantially while the consumption of glibenclamide has decreased. The largest increase in consumption rates was seen in China and India where the consumption has increased rapidly in the last six years.

Lessons learned: Costs and availability of diabetes treatment varied enormously between countries and sectors. To reduce the price for patients and increase the availability of diabetes treatment, policy changes are needed and purchasing and distribution systems have to be improved. Insulin can be purchased at reduced prices by the government through differential pricing initiatives. To reduce the price of diabetes medicines, mark-ups in the public sector have to be reduced. Duties and taxes on all diabetes medicines and supplies need to be removed. Syringes can be made more accessible by delivering syringes together with insulin and diagnostic tools can be made more available by decreasing the variety of different equipment in the public sector.