Availability, prices and affordability of self-monitoring blood glucose devices: surveys in six low-income and middle-income countries.

Introduction: Accessing glucose meters, test strips, lancets and continuous/flash glucose monitoring devices for self-monitoring blood glucose (SMBG) is crucial for the management of diabetes. Yet little is known about access to SMBG devices in low-income and middle-income countries. Methods: In 2022/2023, facility-based surveys were undertaken in selected regions and sectors in Fiji, Indonesia, Kyrgyzstan, Mali, Peru and Vietnam. Availability and patient prices were collected in public sector outlets (hospital dispensaries/clinics) and private pharmacies in the community by in-person visits (except in Mali where it was collected by phone). Data were also collected in medical device shops (Vietnam), online marketplaces (Indonesia) and online from device manufacturers.Availability was assessed as the percentage of outlets with the device in stock on the day of data collection. Median prices were calculated and reported in US dollars (US$). Affordability was assessed as the number of days' wages needed by the lowest-paid unskilled government worker to purchase each device. The affordability of self-monitoring was then compared with that of insulin. Results: SMBG devices were not generally provided to individuals for self-testing by governments in Fiji, Indonesia, Kyrgyzstan and Peru. Public sector availability ranged from 0% to 57% (meters) and 0% to 53% (strips). In private pharmacies, availability was 31% to 100% (meters) and 39% to 100% (strips). Some large regional variations were seen within countries. Median prices for one meter ranged from US$15.62 to US$35.18. For one strip, median prices ranged from US$0.27 to US$0.56. Continuous/flash glucose monitoring devices were only found online at US$88-US$107 per sensor. Between 1.5 and 10.9 days' wages were needed to purchase 1 meter, and 1.0-12.8 days' wages for 50 strips. Online purchases of 1-month supply of continuous/flash device sensors required 15-65 days' wages. The cost of self-testing exceeded the cost of human insulin vials/syringes. However, analogue prefilled pens/pen needles were often higher priced than the cost of self-testing. Conclusion: Poor availability and high prices were found for SMBG devices which can impact diabetes management. Prices of meters, test strips and sensors were unaffordable. Pricing for these essential tools requires further investigation including cost of goods sold; government procurement prices and volumes; and price components in supply chains. Accessing SMBG devices must not be considered in isolation to accessing insulin. Governments need to include SMBG devices in their package of essential diabetes services. They must also support ongoing monitoring to ensure people are accessing SMBG devices.