Affordability of Diabetes Medicines in Iran: A scenario- based assessment

Introduction: Evidence indicates that out-of-pocket payments for prescription medications are imposing a financial burden, reducing medication adherence, and worsening health outcomes, particularly among low- and middle-income patients with chronic diseases. Diabetes is one of the main four major non-communicable diseases (NCDs) is the 9th and16th leading cause of death in women and men in Iran, respectively. The aim of this study was to assess the affordability of diabetes medication on patients during medication therapy in the Iran health system context. Method: This paper presents a scenario-based assessment of diabetes medicines affordability in Iran, 2017. To do that, different medication therapyscenarios were defined in mono- and combination therapy and dose/schedule adjusted approaches. Then the affordability of each scenario investigated in type 1 and type 2 diabetes utilizing the World Health Organization/Health Action International Methodology, and the clinician opinions for registered diabetes medicines in Iran. We analyzed costs data during one month of chronic treatment. Data were analyzed forgeneric products and in the public sector_ As the dominant sector _. Results: The results show that from 38 diabetes medicines in IDL, 10, 4, and 13 cases are non- affordable in monotherapy scenarios including DDD method, the Minimum method, and the Maximum method, respectively. Then, dose/schedule adjusted scenarios _based on the guidelines and experts’ opinion_ for type 1 and type 2 diabetes wereidentified. The scenarios are monotherapy therapy, dual drug therapy, triple-drug therapy and insulin therapy for a 30-day period. The results show that monotherapy, dual, and triple (non-insulin) therapies with the lowest-paid unskilled worker approach can be affordable by DDD, minimum, and maximum methods. However, triple therapy (include insulin) scenarios and some insulin therapy scenarios are nonaffordable.Conclusions: Finding a way to make prescription medicines—and health care at large—more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual s insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability and catastrophic issue will require considering all of these factors together. High rates of catastrophic costs show that patients with type 2 diabetes that are resistant to medication therapy and patients with type 1 diabetes in Iran incur substantial costs and new policies are urgently neededto ensure diabetes medication is actually affordable.

کلیدواژه ها:

Diabetes ، Affordability ، Type 1 and 2 diabetes ، Medication cost ، Iran health care system