Company-supported programmes with free or discounted insulin in low- and middle-income countries

Introduction : the Addressing the Challenge and Constraints of Insulin Sources and Supply (ACCISS) Study aims to identify the barriers to equitable access to insulin in low- and middle-income countries (LMIC). Within ACCISS, the current study describes and estimates the magnitude of company-supported insulin donation and discount programmes in LMICs. These programmes play a critical role in those counties where the public sector is unable to provide insulin and where the cost in the private sector makes insulin unaffordable. Methods : the main source of data was publicly available information from annual reports and websites of the three main insulin-producing companies and the relevant diabetes foundations, supplemented with information from the Access to Medicine Index Foundation. Information obtained was cross-checked with web searches and direct discussions with companies and foundations, which also provided comments on earlier drafts of the report. Results : the relevant companies and foundations run at least 40 different diabetes-related initiatives in over 70 LMIC, focusing on disease awareness, patient screening, education, training, and improving health systems. In 51 LMICs the programmes include insulin donations. It is estimated that over the period 2010-2014, between 17,000 and 60,000 type 1 diabetes patients in LMIC received free insulin, per year. A large proportion of the programmes focus on children. Conclusion : in absolute terms these programmes make a very valuable contribution to the health and welfare of these patients, which represent about one-tenth of children with type 1 diabetes globally. The relative impact on public health in LMICs cannot be established as only few donation programmes have been systematically evaluated, and total incidence and prevalence figures of children with type 1 diabetes in LMICs are not available.