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Trop Med Int Health. 2019 Jan;24(1):43-52. doi: 10.1111/tmi.13167. Epub 2018 Nov 13.

Prices, availability and affordability of insulin products: a cross-sectional survey in Shaanxi Province, western China.

Li Z1,2,3, Feng Q4, Kabba JA1,2,3, Yang C1,2,3, Chang J1,2,3, Jiang M1,2,3, Zhao M1,2,3, Yu J1,2,3, Xu S1,2,3, Li Q1,2,3, Zhai P1,2,3, Fang Y1,2,3.

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Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
Shaanxi Center for Health Reform and Development Research, Xi'an, China.
Department of Drug and Equipment, No. 521 Hospital of Ordnance Industry, Xi'an, China.



To evaluate price, availability and affordability of insulin products in Shaanxi Province, western China.


We used a simplified and adapted WHO/Health Action International method to obtain the availability and prices of insulin products and five oral anti-diabetic medicines as comparators in public general hospitals and private retail outlets. In addition, we investigated the price components of eight selected insulin products by tracing the supply chain.


All three kinds of insulin products, prandial, basal and premixed insulin, are 100% available in public hospitals, and have fairly high availability in the private sector (62.5-68.8%). The prices of most insulin products were higher than international reference prices in both sectors (ranging from 0.95 times to 2.33 times). All insulin products were unaffordable as they would cost 3.5-17.1 days' wage of the lowest-paid government workers in Shaanxi. The manufacturer's markup (selling price), which comprised more than 60% of the final price of all insulin products surveyed, was the largest price component.


Although availability of insulin products was high in public general hospitals and private retail pharmacies, their high price made them unaffordable to diabetes patients, especially low-income patients. The government should increase insurance compensation for those who need these life-saving medicines or decrease the cost of insulin products through negotiation with suppliers.


China; Chine; affordability; availability; caractère abordable; composantes des prix; disponibilité; insulin; insuline; price components

[Indexed for MEDLINE]

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