Does the high cost of insulin prevent diabetic patients from taking their medications?

High prices for prescription drugs are becoming a prominent political issue, with medications such as insulin becoming a model in their own right. The price of the diabetes drug has almost doubled from 2012 to 2016 and has attracted the attention of both parties on Capitol Hill and has even been unanimously in a recent special issue of the comedy Netflix.

Voters believe that lowering prices should be a top priority for lawmakers – and that Democratic presidential candidates are paying attention.

Senator Kamala Harris (D-Calif.), A member of the Democrats Group vying for the 2020 bid, answered a question about health care highlighting the exorbitant price of insulin.

"In our country, one in four diabetic patients can not afford to buy insulin," she said.

The researchers point out that this would be a surprisingly high number and that this could become a topic of discussion to which Democrats will return throughout the election campaign. The cost of insulin especially resonates given the incidence rates of diabetes.

According to the American Diabetes Association, about 1.25 million Americans have type 1 diabetes – less common than type 2 – and can not live without insulin.

Keeping that in mind, we decided to dig to see if Harris' statement was checking.

Three different data at the origin of Harris' claim

When asked about this, the Harris campaign cited for the first time a peer-reviewed study published in December on the treatment of diabetics at the Yale Diabetes Center in New Haven, Connecticut. Out of 199 participants, 51% – reported having reduced or stopped taking insulin because of costs.

The study is small and limited to a metropolitan area. But it probably gives a more or less accurate picture at the national level, said three university researchers specializing in health care.

"The characteristics of the included people seem pretty well distributed among the measures we think about, such as age, type of insurance, race, ethnicity," said Stacie Dusetzina, a professor. Aggregated Health Policy at Vanderbilt University. "They are probably pretty much on target."

The study also corresponds to other surveys, although they also have limitations.

One, commissioned by the American Diabetes Association and made public last May, surveyed approximately 530 people online whose demographics matched the national data of people with the disease. About 27% of respondents suggested that the price of insulin had "affected their purchase or use of insulin over the last year".

There is also an online membership survey administered by T1 International, a rights advocacy group for people with diabetes. Its results and methodology for 2018 are currently the subject of a peer review and have not yet been fully published, said James Elliott, one of the board's directors. 39; organization. He suggested that this would likely ultimately support Harris's "1 of 4" talking point.

There are extrapolations, but the point is "more true than not"

The caveat is that Harris's comment is based on limited data and only one of the documents has been peer-reviewed.

Although the price of insulin has skyrocketed in recent years, no major survey or national study has determined the affordability of insulin, said Dr. Jing. Luo, an instructor at Harvard Medical School, who participated in Yale's study and looked at the price of insulin.

This may limit any attempt to debate insulin access at the national level or at the very least require extrapolation.

That said, the number 1 out of 4 is "more real than improbable," Luo said.

"It's as accurate as the data available allow," Luo said. "It's a reasonable estimate." Really, there's no data suggesting the opposite. "

We also asked about Harris's specific word choice: "can not afford their insulin". All research on this question does not ask this specific question, but rather whether the cost has prompted the patient to buy or use fewer drugs.

According to badysts, this is actually a good indicator that people can not afford insulin or not. And this may underestimate the problem, said Dr. Kasia Lipska, the endocrinologist who led the Yale study, in that it ignores people who continue to buy drugs, but neglect to do so. their shopping or other necessities.

Our decision

The absence of a national study is a problem, of course, and to some extent limits the extent to which we can inventory the 1 in 4 figure of Harris. It is also important to remember that it applies to a smaller group – only patients with type 1 – rather than all people with diabetes.

But experts widely suggested that the findings of the three reports mentioned – a peer-reviewed academic article and two surveys – amply supported his claims. And the broad sense of the phrase "can not afford" means that the problem might be more important than suggested by these datasets, as they only measure people not taking drugs, not those who which the price of insulin can create other financial problems.

This statement is accurate but requires some additional information. We evaluate this statement essentially true.