Insulin Still Unattainable for Many Living with Diabetes Worldwide: ACCISS Study Review in The Lancet D&E


An ACCISS Study Review of the global insulin market, called ‘Constraints and Challenges in Access to Insulin: A Global Perspective, was published Friday in The Lancet Diabetes & Endocrinology. Co-authored by ACCISS Study leaders, David Beran, Marg Ewen and Richard Laing, the Review describes why insulin is still unattainable for approximately half of all people who need it. It is based on a broader October 2015 Report by the ACCISS team, ‘Access to Insulin: Current Challenges and Constraints‘.

While lead author, David Beran, is the first to admit, “Insulin access is a complex challenge,” there are clear issues that affect access to insulin. These include the global insulin market being dominated by three multinational manufacturers, import duties and taxes affecting the price insulin entering different countries, and mark ups in the public and private sectors.

These wide-ranging barriers are having a crippling effect on countries’ health systems, as well as individuals with diabetes and their families. In Mozambique, for example, the health expenditure per capita for insulin is 120% (1-3).

In countries where insulin is not provided free of charge, the cost is having a devastating effect on families. In Malawi, Nepal and Sri Lanka, for instance, where insulin is not provided free of charge, the lowest paid unskilled government worker must work 19.6, 7.3 and 6.1 days, respectively, just to cover the monthly cost of human insulin treatment (4).

Despite the assumption that insulin is more affordable in developed countries, the Review found this to not be the case. In the United States, for example, insulin costs are increasing for users due, in part, to the rising use of analogues. In fact, between 2000 and 2010, the out-of-pocket expense for analogue insulin for those living with type 2 diabetes increased from $19 to $36 (5).

The aim of the Review, which is the first step in the ACCISS Study research, is to bring these critical issues to light and inspire further action and support for the Study’s work.

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Quick Links:

(1)World Heath Organization. Core Health Indicators, 2005.
(2)Yudkin, JS. Insulin for the world’s poorest countries. Lancet 2000:355:919-21.
(3) Management Sciences for Health’s. International Drug Price Indicator Guide. 2015.
(4)Medis S, Fukino K, Cameron A, et al. The availability and affordability of selected  essential medicines for chronic disease in six low-and middle-=income countries. Bull World Health Organ 2007:85:279 – 88
(5)Lipska KJ, Ross JS, Van Houten HK, Beran D, Yudkin JS, Shah ND. Use and out-of-pocket costs of insulin for type 2 diabetes mellitus from 200 through 2010. JAMA 2014;331:2331-33.