Sarayani Amir, Rashidian Arash, Gholami Kheirollah
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
BMJ Open. 2014 Oct 16;4(10):e005859. doi: 10.1136/bmjopen-2014-005859.
Diabetes is a major public health concern worldwide, particularly in low-income and middle-income countries (LMICs). Limited data exist on the status of access to diabetes medicines in LMICs. We assessed the utilisation and affordability of diabetes medicines in Iran as a middle-income country.
We used a retrospective time-series design (2000-2012) and assessed national diabetes medicines' utilisation using pharmaceuticals wholesale data.
We calculated defined daily dose consumptions per population days (DDDs/1000 inhabitants/day; DIDs) indicator. Findings were benchmarked with data from Organization for Economic Co-operation and Development (OECD) countries. We also employed Drug Utilization-90% (DU-90) method to compare DU-90s with the Essential Medicines List published by the WHO. We measured affordability using number of minimum daily wage required to purchase a treatment course for 1 month.
Diabetes medicines' consumption increased from 4.47 to 33.54 DIDs. The benchmarking showed that medicines' utilisation in Iran in 2011 was only 54% of the median DIDs of 22 OECD countries. Oral hypoglycaemic agents consisted over 80% of use throughout the study period. Regular and isophane insulin (NPH), glibenclamide, metformin and gliclazide were the DU-90 drugs in 2012. Metformin, glibenclamide and regular/NPH insulin combination therapy were affordable throughout the study period (∼0.4, ∼0.1, ∼0.3 of minimum daily wage, respectively). While the affordability of novel insulin preparations improved over time, they were still unaffordable in 2012.
The utilisation of diabetes medicines was relatively low, perhaps due to underdiagnosis and inadequate management of patients with diabetes. This had occurred despite affordability of essential diabetes medicines in Iran. Appropriate policies are required to address the underutilisation of diabetes medicines in Iran.
糖尿病是全球主要的公共卫生问题，在低收入和中等收入国家（LMICs）尤为突出。关于LMICs获取糖尿病药物的现状数据有限。我们评估了作为中等收入国家的伊朗糖尿病药物的使用情况和可负担性。
我们采用回顾性时间序列设计（2000 - 2012年），并利用药品批发数据评估全国糖尿病药物的使用情况。
我们计算了每千人口日限定日剂量消耗量（DDDs/1000居民/天；DIDs）指标。研究结果与经济合作与发展组织（OECD）国家的数据进行了对比。我们还采用药物利用90%（DU - 90）方法，将DU - 90与世界卫生组织发布的基本药物清单进行比较。我们通过购买一个月治疗疗程所需的最低工资数量来衡量可负担性。
糖尿病药物的消费量从4.47 DIDs增加到33.54 DIDs。对比显示，2011年伊朗的药物使用量仅为22个经合组织国家DIDs中位数的54%。在整个研究期间，口服降糖药的使用占比超过80%。2012年，常规胰岛素和低精蛋白胰岛素（NPH）、格列本脲、二甲双胍和格列齐特是DU - 90药物。在整个研究期间，二甲双胍、格列本脲和常规/NPH胰岛素联合治疗是可负担的（分别约为最低工资的0.4、0.1、0.3）。虽然新型胰岛素制剂的可负担性随时间有所改善，但在2012年它们仍然难以负担。
糖尿病药物的使用相对较低，可能是由于糖尿病患者诊断不足和管理不善。尽管伊朗基本糖尿病药物具有可负担性，但仍出现了这种情况。需要制定适当政策来解决伊朗糖尿病药物使用不足的问题。
