[EQ] Medicine prices, availability, and affordability in 36 developing and middle-income countries

Essential medicines out of reach for most people

 

WHO World health Organization: http://www.who.int/mediacentre/news/releases/2008/pr45/en/index.html

HAI - Health Action International: http://www.haiweb.org/medicineprices/

Full article PDFat: http://www.haiweb.org/medicineprices/01122008/MedPrices%20-%20Word.pdf

“….1 December 2008 | WHO GENEVA -- An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in today’s online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.

 

The study analysed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days' salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days' wages….”

 

Medicine prices, availability, and affordability in 36 developing and middle-income countries:
a secondary analysis

The Lancet, Early Online Publication, 1 December 2008 doi:10.1016/S0140-6736(08)61762-6

 

A Cameron MPH a   , M Ewen Dip Pharm b, D Ross-Degnan ScD c, D Ball PhD d, R Laing MD e
Essential Medicines and Pharmaceutical Policies, World Health Organization, Geneva, Switzerland (A Cameron MPH); Health Action International, Amsterdam, Netherlands (M Ewen Dip Pharm); Harvard Medical School and Harvard Pilgrim Health Care, Boston MA, USA (D Ross-Degnan ScD); Pharmaceutical consultant, Manila, Philippines (D Ball PhD); and Essential Medicines and Pharmaceutical Policies, World Health Organization, Geneva, Switzerland (R Laing MD)

Website:http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61762-6/fulltext
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WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, and price components in low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and subnational surveys done using the WHO/HAI methodology

 

Methods

Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing power parity. International reference prices from open international procurements for generic products were used as comparators. Results are presented for 15 medicines included in at least 80% of surveys and four individual medicines.

 

Findings

Average public sector availability of generic medicines ranged from 29•4% to 54•4% across WHO regions. Median government procurement prices for 15 generic medicines were 1•11 times corresponding international reference prices, although purchasing efficiency ranged from 0•09 to 5•37 times international reference prices. Low procurement prices did not always translate into low patient prices. Private sector patients paid 9—25 times international reference prices for lowest-priced generic products and over 20 times international reference prices for originator products across WHO regions. Treatments for acute and chronic illness were largely unaffordable in many countries. In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount charged varied from 4% to 15%.

 

Interpretation

Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable. Policy options such as promoting generic medicines and alternative financing mechanisms are needed to increase availability, reduce prices, and improve affordability.

 

 

 

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