{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T03:16:40Z","timestamp":1794021400552,"version":"4.8.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"unspecified","delay-in-days":52,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"FIND","award":["KFW-TBBU02"],"award-info":[{"award-number":["KFW-TBBU02"]}]},{"DOI":"10.13039\/100007028","name":"The Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"crossref","award":["G-2302-06660"],"award-info":[{"award-number":["G-2302-06660"]}],"id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,1,29]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>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\u2019 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2013US$107 per sensor. Between 1.5 and 10.9\u2009days\u2019 wages were needed to purchase 1 meter, and 1.0\u201312.8\u2009days\u2019 wages for 50 strips. Online purchases of 1-month supply of continuous\/flash device sensors required 15\u201365\u2009days\u2019 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001128","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T20:20:26Z","timestamp":1740255626000},"page":"e001128","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Availability, prices and affordability of self-monitoring blood glucose devices: surveys in six low-income and middle-income countries"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1177-4717","authenticated-orcid":false,"given":"Margaret","family":"Ewen","sequence":"first","affiliation":[{"name":"Health Action International, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Lepeska","sequence":"additional","affiliation":[{"name":"Health Action International, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Abdraimova","sequence":"additional","affiliation":[{"name":"Health Policy Analysis Center, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3779-3441","authenticated-orcid":false,"given":"St\u00e9phane","family":"Besan\u00e7on","sequence":"additional","affiliation":[{"name":"Sant\u00e9 Diab\u00e8te, Bamako, Mali"},{"name":"Laboratoire MESuRS (Mod\u00e9lisation, \u00c9pid\u00e9miologie et Surveillance des Risques Sanitaires) au Conservatoire National des Arts et Meti\u00e9rs (CNAM), Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Thi Phuong","family":"Cham","sequence":"additional","affiliation":[{"name":"Consultant, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asel","family":"Dunganova","sequence":"additional","affiliation":[{"name":"Health Policy Analysis Center, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moise","family":"Nguemeni","sequence":"additional","affiliation":[{"name":"Sant\u00e9 Diab\u00e8te, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lachlan","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2837-5149","authenticated-orcid":false,"given":"Janeth","family":"Tenorio-Mucha","sequence":"additional","affiliation":[{"name":"CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesty Utami","family":"Ramadaniati","sequence":"additional","affiliation":[{"name":"Centre for Pharmaceutical Policy, Management and Service Studies, Pancasila University, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7898-472X","authenticated-orcid":false,"given":"Beatrice","family":"Vetter","sequence":"additional","affiliation":[{"name":"FIND, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7229-3920","authenticated-orcid":false,"given":"David","family":"Beran","sequence":"additional","affiliation":[{"name":"Division of Tropical and Humanitarian Medicine, University of Geneva and Generva University Hospitals, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"2025083110352464000_3.1.e001128.1","unstructured":"UN General Assembly high-level meetings on prevention and control of non-communicable diseases. Available: https:\/\/www.who.int\/teams\/noncommunicable-diseases\/on-the-road-to-2025 [Accessed 3 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.2","unstructured":"World Health Organization Global Diabetes Compact. Available: https:\/\/www.who.int\/initiatives\/the-who-global-diabetes-compact [Accessed 3 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.3","unstructured":"World Health Assembly resolution 74.4. Reducing the burden of noncommunicable diseases through strengthening prevention and control of diabetes. Available: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA74\/A74_R4-en.pdf [Accessed 3 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.4","unstructured":"75th World Health Assembly targets for diabetes. Available: https:\/\/www.who.int\/news-room\/feature-stories\/detail\/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75-th-world-health-assembly [Accessed 3 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.5","unstructured":"World Health Organization . The selection and use of essential in vitro diagnostics. WHO Technical Report Series 1053; 2023. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/373322\/9789240081093-eng.pdf [accessed 28 Oct 2023]"},{"key":"2025083110352464000_3.1.e001128.6","unstructured":"Khardori R . Type 1 diabetes mellitus treatment & management. Medscape; 2024. Available: https:\/\/emedicine.medscape.com\/article\/117739-treatment#d7?form=fpf"},{"key":"2025083110352464000_3.1.e001128.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-001410","article-title":"Insulin prices, availability and affordability in 13 low-income and middle-income countries","volume":"4","author":"Ewen","year":"2019","journal-title":"BMJ Glob Health"},{"key":"2025083110352464000_3.1.e001128.8","unstructured":"Prices people pay for glargine insulin. A snapshot of the price of glargine in 47 countries. Available: https:\/\/accisstoolkit.haiweb.org\/2023-glargine-snapshot-survey [Accessed 12 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.9","unstructured":"Pfiester E , Braune K , Thieffry A , et al . Costs and underuse of insulin and diabetes supplies: findings from the 2020 t1international cross-sectional web-based survey. Available: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0168822721003557 [Accessed 14 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.10","unstructured":"Health Action International . 2016 Insulin prices profile, ACCISS study. 2016. Available: https:\/\/haiweb.org\/wp-content\/uploads\/2016\/04\/ACCISS-Prices-report_FINAL-1.pdf"},{"key":"2025083110352464000_3.1.e001128.11","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/S2213-8587(18)30074-3","article-title":"Blood glucose meters and test strips: global market and challenges to access in low-resource settings","volume":"7","author":"Klatman","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2025083110352464000_3.1.e001128.12","unstructured":"Tanzania NCD Alliance . Availability, prices and affordability of insulin, insulin syringes, glucose meters, and test strips in Tanzania. 2020."},{"key":"2025083110352464000_3.1.e001128.13","doi-asserted-by":"crossref","first-page":"21","DOI":"10.18553\/jmcp.2012.18.1.21","article-title":"Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes","volume":"18","author":"Yeaw","year":"2012","journal-title":"JMCP"},{"key":"2025083110352464000_3.1.e001128.14","unstructured":"Health Action International website. Available: https:\/\/haiweb.org\/projects\/acciss-study\/ [Accessed 15 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.15","unstructured":"WHO\/HAI . Measuring medicine prices, availability, affordability and price components. 2008. Available: https:\/\/haiweb.org\/what-we-do\/priceavailability-affordability\/collecting-evidence-on-medicine-prices-availability\/ [Accessed 15 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.16","unstructured":"Currency Converter | Foreign Exchange Rates | OANDA. n.d. Available: https:\/\/www.oanda.com\/currency-converter\/en"},{"key":"2025083110352464000_3.1.e001128.17","unstructured":"American Diabetes Association . Diabetes technology: standards of medical care in diabetes\u20142023 | diabetes care. Available: https:\/\/diabetesjournals.org\/ [Accessed 22 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.18","unstructured":"ISPAD clinical practice consensus guidelines 2022. Available: https:\/\/www.ispad.org\/page\/ISPADGuidelines2022 [Accessed 22 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.19","unstructured":"WHO Collaborating Centre for Drug Statistics Methodology. ATC\/DDD Index; 2023. Available: https:\/\/www.whocc.no\/atc_ddd_index\/ [Accessed 12 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.20","unstructured":"Social Health Protection Network . Indonesia. Available: https:\/\/p4h.world\/en\/countries\/indonesia\/ [Accessed 24 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.21","unstructured":"Social Health Protection Network . Vietnam, Available: https:\/\/p4h.world\/en\/countries\/vietnam\/ [Accessed 24 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.22","first-page":"s243","article-title":"The health system of Peru","volume":"53 Suppl 2","author":"Alcalde-Rabanal","year":"2011","journal-title":"Salud Publica Mex"},{"key":"2025083110352464000_3.1.e001128.23","unstructured":"FIND and market access Africa, data on file at FIND, estimates as per October 2021. 2021"},{"key":"2025083110352464000_3.1.e001128.24","unstructured":"New Zealand PHARMAC pharmaceutical schedule. Available: https:\/\/schedule.pharmac.govt.nz\/ScheduleOnline.php [Accessed 10 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.25","unstructured":"US Veterans Affairs Pharmaceutical Prices, Available: https:\/\/www.va.gov\/opal\/nac\/fss\/pharmprices.asp [Accessed 22 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.26","doi-asserted-by":"crossref","DOI":"10.1111\/dme.15089","article-title":"Use of continuous glucose monitors in low\u2010 and middle\u2010income countries: A scoping review","volume":"40","author":"Bernabe\u2010Ortiz","year":"2023","journal-title":"Diabet Med"},{"key":"2025083110352464000_3.1.e001128.27","unstructured":"UK NHS electronic drug tariff. Available: https:\/\/www.drugtariff.nhsbsa.nhs.uk\/#\/00867022-DC\/DC00866575\/Part%20IXR%20-%20Chemical%20Reagents%20 [Accessed 10 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.28","unstructured":"MAIn tool (Monitoring Access to Insulin), Heath Action International. Available: https:\/\/accisstoolkit.haiweb.org [Accessed 24 Oct 2024]."},{"key":"2025083110352464000_3.1.e001128.29","unstructured":"ACCISS Study . Market report: diabetes self-monitoring devices in low- and middle-income countries. CHAI; 2021. Available: https:\/\/haiweb.org\/wp-content\/uploads\/2021\/09\/Market-Report_Self-monitoring-Devices-in-LMICs.pdf [accessed 12 Oct 2023]"},{"key":"2025083110352464000_3.1.e001128.30","unstructured":"Roche, Accu-Chek SugarView. Available: https:\/\/www.rochediabetescaremea.com\/en\/meter-systems\/sugarview [Accessed 1 Nov 2024]."},{"key":"2025083110352464000_3.1.e001128.31","unstructured":"WHO Global Diabetes Compact. Available: https:\/\/www.who.int\/initiatives\/the-who-global-diabetes-compact [Accessed 20 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.32","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0140-6736(08)61762-6","article-title":"Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis","volume":"373","author":"Cameron","year":"2009","journal-title":"The Lancet"},{"key":"2025083110352464000_3.1.e001128.33","unstructured":"World Health Organization . Technical briefing for appendix 3 of the global action plan for non-communicable diseases. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/ncds\/mnd\/technical-brief-diabetes.pdf?sfvrsn=5b304706_8 [Accessed 28 Oct 2023]."},{"key":"2025083110352464000_3.1.e001128.34","doi-asserted-by":"crossref","unstructured":"Abdraimova A , et al . n.d. Management of type 1 diabetes in low- and middle-income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania. doi:10.1111\/dme.14891","DOI":"10.1111\/dme.14891"},{"key":"2025083110352464000_3.1.e001128.35","doi-asserted-by":"crossref","unstructured":"Howitt P , Darzi A , et al . Technologies for Global Health. The Lancet Commission 2012. doi:10.1016\/S0140-6736(12)61989-8","DOI":"10.1016\/S0140-6736(12)61989-8"},{"key":"2025083110352464000_3.1.e001128.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0309062","article-title":"Development of a target product profile for new glucose self-monitoring technologies for use in low- and middle-income countries","volume":"19","author":"Safary","year":"2024","journal-title":"PLoS One"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-001128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:35:36Z","timestamp":1756661736000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-001128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2,22]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjph-2024-001128"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-001128","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}