Costs and Underuse of Insulin and Diabetes Supplies: Findings from the 2020 T1International Cross-Sectional Web-based Survey

To investigate self-reported out-of-pocket expenses associated with insulin and diabetes supplies for people living with type 1 diabetes (T1D) worldwide. A web-based, cross-sectional survey was conducted from August to December 2020. The analysis included comparisons between responses from countries with no, partial, and full healthcare coverage. 1,066 participants from 64 countries took part in the study. ∼25% of respondents reported having underused insulin at least once within the last year due to perceived cost. A significant correlation was observed between OoPEs and reported household income for respondents with partial healthcare coverage. 63.2% of participants reported disruption of insulin supplies and 25.3% reported an increase of prices related to the COVID-19 pandemic. This study confirms previous reports of ∼25% of people in the US with T1D using less insulin and/or fewer supplies at least once in the last year due to cost, a trend associated with the extent of healthcare coverage. Similar trends were observed in some middle/low income countries. Moreover, patients reported an increase in insulin prices and disruption of supplies during the COVID-19 pandemic. This study highlights the importance of self-reported OoPEs and its association with underuse/rationing of insulin.