Table 4.

Medication costs, per patient per year

Country/study	Setting	Diabetes type	Cost per medication, per patient, per year (2016 US$)
			Insulin*	NPH insulin	Analogue insulin	Oral medications†	Glibenclamide	Metformin	CVD medications‡	Antidiabetic§
Data reported by patients
Lower middle-income countries
Solomon Islands35	SC	2	18.83			27.20			12.55
Data from provider/system perspective
Low-income countries
Malawi15	Supply	1	450.00
Central African Republic15	Supply	1	335.16
Somalia15	Supply	1	180.00
Burkina Faso15	Supply	1	180.00
Nepal15	Supply	1	135.00
Benin15	Supply	1	144.00
Lower middle-income countries
Cambodia57	Supply	2	117.72			25.60	3.09	25.76
Mauritania15	Supply	1	140.22
Cambodia15	Supply	1	180.00
Pakistan15	Supply	1	4.98
Mongolia15	Supply	1	0.00¶
Cote d’Ivoire15	Supply	1	91.80
India15	Supply	1	103.50
India58	SC	2	439.83
Upper middle-income countries
Iran59	SC-Public	2	79.28				95.71
	Private	2	81.41				57.83
Iran60	SC	2		63.24	236.04
Jordan61	SC	DM	91.82** 391.08††
Jordan62	SC	2		393.78	952.69
Serbia63	Unclear	2	56.43			35.13
Ecuador15	Supply	1	109.80
Bulgaria64	SC	1	481.89
St Lucia15	Supply	1	0.00¶
China65	SC	DM							494.44	466.38
Brazil48	SC	1	384.59			30.88
Brazil66	SC	2	49.93	7.68	12.80				21.77	70.42
Data from both patient and provider perspectives
Lower middle-income countries
Vietnam67	Missing	1 and 2	90.87			378.44
Philippines67	Missing	1 and 2	242.19			165.17
Upper middle-income countries
China68	SC	2						270.31
China69	SC	2						257.72
Mexico46	PC	2					5.16	12.02
Brazil55	SC	2							278.47	124.38
Argentina70	Public	2		518.69	1555.24‡‡ 1036.83‡‡ 945.59§§			250.50

Some studies also included other medicines: antibiotics³⁵; pain relief/anti-inflammatory drugs³⁵; gliflozin class drugs⁶⁸; sulfonylureas^{68 69}; metformin combinations (with glibenclamide,⁴⁶ with DPP4i).⁷⁰ An additional study included medication costs per complication without breaking this out by specific medication.⁴⁵

*Indicated as (non-specific) insulin in study text.

†Indicated as group of oral antidiabetic medications (non-specified per drug) in study text (excluding medicines for comorbidities such as CVD); any specifications included as footnotes here.

‡Includes lipid-lowering medicines, antiplatelet, antihypertensive drugs. All antidiabetic medications summed together (ie, the cost of insulin plus oral antidiabetic medications).

§Insulin provided free of charge to surveyed health facilities in this country.

¶Insulin vials.

**Insulin cartridges.

††Levemir.

‡‡Insulin lispro.

CVD, cardiovascular disease; DM, diabetes mellitus; NPH, neutral protamine Hagedorn; PC, primary care; SP, specialised care.