Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran

Leila Zarei, Najmeh Moradi, Farzad Peiravian, Nazafiran Hatami Mazinani, Motahareh Mahi Birjand, Jalal Arabloo, Zaheer-Ud-Din Babar

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives
This study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran.

Method
The “budget share” and “capacity to pay” approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules.

Results
The results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach.

Conclusions
Assessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship.
Original languageEnglish
Article number188
Number of pages10
JournalInternational Journal for Equity in Health
Volume21
Issue number1
DOIs
Publication statusPublished - 29 Dec 2022

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