In the poorest countries a health-economics team looked at, one month of a GLP-1 weight-loss and diabetes drug can cost more than a full month's minimum wage. At the extreme, it ran to 110.4 percent of it. The cheaper diabetes pills in the same comparison never passed 5.1 percent.
The numbers come from a cross-sectional study published July 24 in BMJ Open ↗ by three researchers at Fudan University's School of Public Health in Shanghai. They priced every marketed SGLT-2 inhibitor and GLP-1 receptor agonist, 22 drugs in all, across ten countries chosen to span income levels: Nepal, Pakistan, Bangladesh, Sri Lanka, South Africa, Brazil, China, Türkiye, Italy and France.
What a month costs
Both drug classes are now standard recommendations for people whose diabetes comes with heart or kidney disease, which is a large and growing group worldwide. The question the Fudan team asked is a plain one: if a doctor in each country wanted to prescribe these drugs, could they even buy them, and could a patient afford them.
Availability alone varied sharply. Nepal had just 2 of the 22 drugs approved for sale. China had 15. Across the ten countries, regulatory approval covered anywhere from 9.1 to 68.2 percent of the list.
Price split the two classes cleanly. A month of an SGLT-2 inhibitor, the pill side of the comparison, ran from 3.68 to 50.30 US dollars. A month of a GLP-1 drug, the injectable side, ran from 22.95 to 220.80 dollars. Turned into affordability, the share of a national minimum monthly wage needed to buy one month of treatment, SGLT-2 inhibitors took 0.7 to 5.1 percent. GLP-1 drugs took 1.6 to 110.4 percent.
The part that stings for poorer countries
There is a pattern hiding in those ranges. SGLT-2 inhibitor prices tracked how rich a country was, climbing with GDP per capita in near-lockstep (a Spearman correlation of 0.939, where 1.0 would be perfect). GLP-1 prices showed no such link. In plain terms, the pills got cheaper where incomes were lower, and the injections did not. A GLP-1 drug tends to carry something closer to a global sticker price, so the same dollar figure eats a small slice of an Italian wage and a whole month of a Nepali one.
The team also found that countries with stronger drug regulators had approved more GLP-1 drugs (a statistically detectable link, p=0.045), while SGLT-2 availability did not depend on regulatory capacity.
The class everyone is talking about is the GLP-1 side. Semaglutide ↗, sold as Ozempic and Wegovy, and tirzepatide ↗, sold as Mounjaro and Zepbound, are the GLP-1 receptor ↗ drugs driving the demand. They are peptides, manufactured and shipped cold, which is part of why they sit at the expensive end. SGLT-2 inhibitors are small-molecule pills, cheaper to make and to move, and it shows in the affordability gap.
The authors are careful about what this is. The sample is ten countries, the analysis is exploratory and hypothesis-generating, and the prices are retail list figures, not what a national insurer or a manufacturer access program might actually pay. What it establishes is a shape worth watching as the GLP-1 rollout reaches lower-income health systems: the drug with the most momentum is also the one whose price bends least to what a patient can pay.