title: Low utilisation of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We used a retrospective time-series design (2000-2012) and assessed national diabetes medicines' utilisation using pharmaceuticals wholesale data.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Sarayani
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.|Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Research Center for Rational Use of Drugs and Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kheirollah
authors.initials: K
authors.lastname: Gholami
mesh_terms: D019985:Benchmarking; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000188:drug therapy*; D016527:Drug Costs / Q000639:trends*; D004363:Drug Utilization / Q000639:trends*; D006297:Health Services Accessibility; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D065186:Interrupted Time Series Analysis; D007492:Iran; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents