Over 14% diabetes patients face catastrophic health expenditure
Stakeholders say over the past year, there has been a noticeable surge in the prices of various medications, including those used to treat diabetes.
A significant portion of diabetic patients in Bangladesh are struggling under the weight of catastrophic health expenditure due to the soaring costs of medical care, including diabetes test strips, insulin, and oral medications.
Data from a recent study shows that soaring medical expenses put over 14% of diabetes patients at risk of financial ruin.
According to the Bangladesh Endocrine Society, approximately 1.31 crore people are dealing with diabetes in Bangladesh, placing the country at the eighth position globally in terms of the number of diabetes patients.
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Stakeholders say over the past year, there has been a noticeable surge in the prices of various medications, including those used to treat diabetes.
This trend has been observed across the market, with several commonly prescribed diabetes drugs experiencing significant price hikes.
For instance, the price of Comprid 80 mg, a diabetes medication, has increased from Tk7 to Tk8 per strip in the last two months alone. Similarly, the price of Lijenta 2.5/500 has risen from Tk12 to Tk13 per strip, while Metformin has seen a price increase from Tk4 to Tk5.
Insulin prices have experienced the most significant increase, with Abasaglar insulin jumping from Tk1,084 to Tk1,280 per vial. Similarly, the price of Humalog Kwikpen insulin has climbed from Tk870 to Tk925.
The escalating costs extend beyond insulin to diabetes test strips as well. For instance, Accu Chek Active Strip, a commonly used diabetes test strip, has seen a price increase from Tk1,100 to Tk1,260 in the past six months.
The price of all types of medicines has increased by 20% in Bangladesh in the last two months, according to Rasel Mahmud, manager of Lazz Pharma's Dhaka Medical branch.
These price hikes pose a significant financial burden on Bangladeshi diabetes patients.
Mahbuba Jahan, a 72-year-old woman who was diagnosed with diabetes eight years ago, is now spending around Tk4,000 per month on insulin. She said she is now considering taking insulin three times a day instead of four times a day to save money.
Sheuli Akter, 24, diagnosed with gestational diabetes, requires insulin four times daily. The recommended insulin, costing Tk1,200 for a three-day supply, has been discontinued by her husband, a small businessman, due to financial constraints. At eight months pregnant, Sheuli is currently not undergoing any diabetes treatment.
"I have entrusted everything to Allah. Inshallah, both the baby and I will be fine, but I cannot afford any more expenses," she said.
Dr Shahjada Selim, associate professor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), said without timely intervention, this situation is likely to escalate.
"Ensuring coordinated action plans at all levels and fostering collaborative management in diabetes care, including the availability of affordable medicines, is of paramount importance," he said.
The study
Researchers from Bangladesh Institute of Development Studies (BIDS) and Institute of Health Economics, University of Dhaka conducted the study titled "Out-of-pocket expenditure among patients with diabetes in Bangladesh: A nation-wide population-based study" based on data collected in 2017.
Some 2,887 diabetes patients from 2,664 households were included in the study. The study was published in September 2023.
According to the study, the yearly average out-of-pocket expense for each diabetes patient was $323 (Tk25,473) in 2017. Medication costs emerged as the primary driver, accounting for 75.43% of the total out-of-pocket expenditure. The incidence of catastrophic health expenditure stood at 14.34%.
The study revealed a significant association between patients aged over 60, lacking education, having comorbid conditions, residing in rural areas, and being in the poorest asset quintile with the incidence of catastrophic health expenditure (CHE) related to diabetes treatment.
Rural households (17%), particularly in the Barisal division (19.5%), experienced a higher burden of CHE. Patients utilising private healthcare facilities exhibited the highest percentage of CHE at 22%.
Dr Abdur Razzaque Sarker, health economist at BIDS and one of the researchers of the study, told TBS that the findings indicate patients bearing medical expenses through borrowing and asset selling, with medication costs being the highest.
"It's crucial to initiate measures to regulate medication prices. Monitoring doctors to prevent prescriptions of overly expensive drugs is essential. Patients, too, should avoid purchasing unnecessary medications without professional advice," he said.
World Diabetes Day is observed annually on 14 November to raise awareness about diabetes. This year's theme for the day is "Access to Diabetes Care".
