Abstract
BackgroundPoor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance.ObjectiveTo check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan.MethodologyA survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient’s affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook.ResultsThe mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day’s wage (median) if using OB and 0.4 day’s wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1).ConclusionThere is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be increased. The prices could be reduced by improving purchasing efficiency, excluding taxes and regulating mark-ups. This could increase the affordability of patients to complete their antibiotic therapy with subsequent reduction in antimicrobial resistance.
Highlights
Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance
World Health Organization (WHO)/HAI methodology includes both public and private sector facilities to be included in the surveys, yet in Pakistan the medicines are provided free of cost in the public sector facilities, in our study, we focused only on private sector data i.e. retail pharmacies, where patients are paying out of pocket to get the medicines
In originator brands (OB) category, only 3 out of 26 surveyed medicines, were in 100 percentile, 5 were in 25 percentile, 3 were in 25–50 percentile, 1 antibiotic was in 51–75 percentile, 7 antibiotics were in 75–99 percentile, while 7 antibiotics Cefazolin, chloramphenicol, cloxacillin, gentamicin, nitrofurantoin, phenoxymethylpenicillin, spectinomycin were not available in any of the pharmacies enrolled in the study
Summary
Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance. Owing to higher medicine prices, it becomes unaffordable for the people living in the low-income countries to buy medicines out of their pockets [3], which compelled them to skip their medical treatment—leading to increase rate of morbidity and mortality [4]. Majority of the health care expenses, including the cost of medicines, are covered by the out-of-pocket expenses, the higher medicines prices majorly contribute in pushing people towards poverty. In this epoch of growing infectious diseases, where a sizable portion of the burden is shared by LMICs, we are totally dependent on antibiotics for the treatment of several life-threatening infectious diseases [5]. The EML has increased in size and has become an evidence-based process, covering efficacy, safety and cost-effectiveness [10]
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