Leila Zarei - Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
Payam Peymani - Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
Najmeh Moradi - Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
Mehrnaz Kheirandish - Assessment and Control of Prescribing and Use of Health Products, Food and Drug Administration, Tehran, Iran
Mahtabalsadat Mirjalili - Shiraz University of Medical Sciences, Shiraz, Iran
Marziyeh Zare - Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

BackgroundDiabetes imposes an enormous burden on patients, families, societies, and healthcare systems. Determining the affordability of medications is an important complicated and vague task, especially in low- and middle-income countries (LMICs). This study aimed to assess the affordability of diabetes medication therapy in Iran’s health system. MethodsThis paper presents a scenario-based assessment of the affordability of all registered anti-diabetes medications in Iran in ۲۰۱۷. To this end, ۴ medication therapy scenarios were defined as mono, dual, triple, and insulin therapy in accordance with the existing guidelines and clinicians’ opinions. Then the affordability ratio of each treatment scenario was determined for type ۱ and type ۲ diabetes drawing on the World Health Organization (WHO)/Health Action International (HAI) Methodology. If the affordability ratio for treatment schedules was more than ۱, the patients’ out-of-pocket (OOP) expenses exceeded the lowest-paid unskilled government worker (LPGW)’ wage per day, and the treatment was labelled as non-affordable. ResultsThe results revealed that the mono, dual, and triple (non-insulin) medication therapies in type ۲ diabetes were affordable, despite an increase in the dosage or a switch from the monotherapy to the combination therapy of oral medications. However, some treatment scenarios in the triple therapy, including oral plus insulin and some insulin only therapies, were proved to be non-affordable. In type ۱ diabetes, only insulin glulisine, detemir, and lispro were non-affordable in monotherapy. Regarding the combination therapy, only isophane insulin with aspart or regular insulin were affordable treatments. ConclusionAlthough oral medication therapies were documented to be affordable, insulin therapy, with current coverage conditions, for patients with lowest paid wages and those receiving even less is unaffordable and a major barrier to treatment; hence, policy-maker should consider targeting and more financial protection policies to improve the affordability of insulin therapies among this group of patients.

Affordability, Diabetes Medicines, Scenario-Based Assessment, Iran