E-DRUG: Research article: Challenges constraining insulin access in Nepal
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Dear E-drug Colleagues
In our recent paper in journal *International Health*, colleagues from
Boston University School of Public Health and Nepal Development society
identify a series of challenges constraining access to insulin in Kathmandu
Valley, Nepal. In particular, we analyzed insulin availability, prices and
affordability in both public and private health sectors using a modified
version of WHO/HAI methodology.
In addition, we explored factors influencing market competition, supply and uptake of insulin 'market dynamics' through qualitative interviews with insulin retailers (pharmacists) and wholesalers.
While increasing number of articles recently have covered
insulin access issues, there remains a need for more empirical evidence
identifying factors constraining insulin access in local context,
especially in LMICs. Our study highlights some of such issues in Nepal - a
low income country with no local insulin production.
Article: Sharma A, Bhandari PM, Neupane D, Kaplan WA and Mishra SR. Challenges
constraining insulin access in Nepal—a country with no local insulin production.
International Health 2018. doi:
https://doi.org/10.1093/inthealth/ihy012
Web link:
https://academic.oup.com/inthealth/advance-article-abstract/doi/10.1093/inthealth/ihy012/4959173
(if you are unable to access online full text article or appendix, feel
free to ask one of the authors via email)
Related media article:
https://www.bu.edu/sph/2018/04/05/access-to-insulin-limited-in-nepal/
SOME HIGHLIGHTS
Results: The mean availability of the two human insulins listed on the 2011
Nepal Essential Medicine List were 14.3% and 42.85% in the surveyed
private- and public-sector pharmacies, respectively, compared with the WHO
target of 80% availability.
The median consumer price of human insulin cartridges, analogue insulin cartridges
and pens was, respectively, 2.1, 4.6 and 5.3 times that of human insulin vials (US$5.54).
The insulin cartridges made in India were less expensive (p<0.001) than those made
elsewhere. The lowest-paid worker would need to spend between 3 and 17
days wages to purchase a monthly insulin supply out of pocket.
Conclusion: The poor availability and lack of affordability of human
insulin in Nepal is consistent with the gradual erosion of the human
insulin market in favour of expensive analogue insulins in many other
countries.
Nepal needs to develop evidence-based clinical guidelines and
consensus statements and to educate healthcare professionals regarding
insulin prescribing that prioritize human insulin. Nepal's existence as a
land-locked country, with the insulin market dominated by a few companies,
and its position as having a single primary gateway (i.e., trading partner
India) for imported insulin poses certain challenges in this regard.
Nepal should employ pooled procurement mechanisms and strategic price
negotiations with companies and develop collaborations with neighbouring
countries to ensure a supply of quality assured, affordable insulin.
Streamlining insulin procurement mechanisms, maintaining cold chain and
storage facilities, monitoring margins and mark-ups and prioritizing the
utilization of human insulin can help make insulin more affordable and
accessible in Nepal.
Thank you !
Abhishek Sharma, BPharm, MPH
Adjunct Researcher
Department of Global Health
Boston University School of Public Health
Boston, MA, USA
Research Fellow/Emerging Leader
World Heart Federation, Geneva, Switzerland
Research Scientist
Precision Health Economics <http://www.precisionhealtheconomics.com/> (Evidence Strategy & Generation)
Vancouver, BC, Canada
abhishek sharma <abhisheksharma0991@gmail.com>