Sunday, November 14, 2010

Diabetes in the World; or a Ramble on Economics

On World Diabetes Day, I'd like to bring your attention to the

Fact: Many people do not have access to insulin due to price and geography.

Sometimes I feel pretty guilty about being able to pay out of pocket for a Dexcom when many people I know cannot afford to test their blood sugar at all. Sometimes I feel guilty when I think about how entitled we in North American and Europe act about getting pumps and test strips and CMGSes when world wide, the majority of people who get diabetes cannot get a regular supply of insulin.
The exact figures as to how many people cannot get insulin, or even approximate figures, are not known.

In this study from 2005 on insulin and syringe availability in Mozambique and Zambia, it was noted that supply of syringes alone reveals that very few people can continue to use insulin every day; assuming a syringe could be used for two weeks, less than 500 people could use the syringes in a year, and more than a hundred thousand people in Zambia have diabetes. The amount of insulin used, and where, also shows that few people are getting insulin. And blood sugar testing is rare.
http://care.diabetesjournals.org/content/28/9/2136.abstract

And while I like to pretend sometimes that it is only in Africa or South America or somewhere far away that people do not get insulin, it happens here too. It happened to somebody while I was reading his blog, in fact. In my years on the online diabetes community, I have heard it a few times.

A sizable portion of the people in the United States have neither health insurance nor the money to pay for doctor visits and insulin and syringes. Companies that manufacture and sell insulin do have programs to help, but awareness is low, and red tape is high, and it is difficult to get the insulin.

The Lilly Cares program, for instance, from the first company to distribute insulin, will give free insulin (Humalog, regular, or NPH) to people at less than three times the poverty line, who are US residents and have no health insurance, and who see a doctor. Lilly sends the insulin to the doctor who is supposed to give it to the patient for free.
The NovoNordisk Patient Asisstance Program requires jumping through more hoops but will cover Levemir, Novolog, NPH, and needles, which they will once again send to a doctor for the patient.
These companies also send insulin to third world countries so that the insulin there costs no more than 1/5th of what it does here, which is still often more than they can afford.
However, I do not see these things by the insulin companies as particularly heroic; it is their faults that insulin prices since 1940 have gone up up up. They charge more for the newer insulins.
Regular or NPH insulin (which is to say, unaltered insulin made to be like human insulin, with no modern innovations) can be gotten as cheap at 60 dollars for 1000 units or 6 cents per unit.
40 years ago, a 10 mL vial of insulin probably contained 400 units and cost no more than 2 dollars (see here). That's 1/2 a cent per unit, for insulin that was more pure than the insulin sold now.
Controlling for inflation, the price of insulin has still doubled since 1970, and that's if you don't use modern insulins. If you want to use a newer insulin (not NPH or Regular) you can expect that you or your insurance will pay twice that.
And that's without looking at the fact that changing to U-100 means that those of us (I use less than 10 units of Lantus per day) who have lower insulin needs will lose money by having to buy insulin in larger containers when it still goes bad.

1 comment:

Wendy said...

BRAVO, JONAH!!!!!

B-R-A-V-O!!!!!!

It makes me SICK how much people must pay for the only treatment that can keep them alive. We're not talking wish list here, people...we're talking LIFE OR DEATH!!!!!

Thank you...again!