Human insulin is currently the most available form of insulin in the world, according to the results of the survey. This is followed by pork, beef and pork/beef mixture, as shown in the figure below.
Animal insulin is considerably cheaper in most countries where both human and animal insulin are available, as indicated in the figure below (see also table on 'Cost of human and animal insulin by region'). In Africa, for example, the average cost of human insulin is twice as expensive as animal insulin. A box of 10 ml U-100 human insulin was cheapest and most expensive respectively in Senegal and Kenya (AFR), Qatar and Libya (EMME), Romania and Italy (EUR), Commonwealth of Dominica and USA (NA), Cuba and El Salvador (SACA), Sri Lanka and Bangladesh (SEA), and Japan and Hong Kong (WP).
Taxes are still a significant factor affecting the price of insulin and other diabetes supplies in a great number of countries even though WHO essential drugs guidelines state that there should be no taxes on insulin. Taxes were added on the price of insulin in 7 out of 8 countries in South and Central America; 5 out of 9 in Africa; 4 out of 8 in the Western Pacific; 12 out of 31 in Europe; 1 out of 3 in South-East Asia; and 2 out of 10 in North America. No taxes were levied in the four responding countries in Eastern Mediterranean and Middle East. Taxes varied from 1% of cost in Kazakhstan to 80% in Poland. Specifically in Africa, it was 14% in South Africa and 48% in Togo.
Cost implications
When the price of insulin is compared to the gross national product (GNP) of the countries, insulin is 3 to 26 times less affordable in Africa than in all other regions (see table on 'Cost reported to GNP of human and animal insulin by region). Human insulin is most affordable in Western Pacific and Europe, and least affordable in Africa while animal insulin is most affordable in South and Central America and Europe, and least affordable in Africa.
The main reason for the expansion of diabetes services in the developed countries was the discovery and introduction of insulin. Developing countries, however, face major scourges including AIDS, TB and malaria, which compete for health priority with diabetes. Although insulin is a life-saving drug, in a situation of grossly restricted medical resources, the 'opportunity cost' of keeping alive a resource-consuming person with diabetes is a valid if chilling question. This explains why four African countries reported that they were aware of people with type 1 diabetes dying because they could not continously access insulin.