Medicine Prices Research Articles

SDG indicator 3.b.3 – an analysis of its robustness and challenges for measuring access to medicines for children

BackgroundSustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines’ accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses.MethodsData on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared.ResultsThe mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0–58.8%) and 76.3% (range 57.2–90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range.ConclusionThis study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework.

Transparency of Medicines Market, from the Global Perspective to the Challenges Faced in Brazil

Transparency on drug costs and prices has been debated in the main areas of high-level governance in recent years. Brazil is one of the signatory countries to the Resolution of the World Health Organization on the transparency of the markets for medicines, vaccines, and other technologies and the transparency of the composition of the price of medicines can have an impact on the Brazilian health system. The aim of this scoping review was through documentary and literature analysis for definitions, characteristics, description, and theoretical grounding of Brazil’s attributes related to the voluntary commitments signed in the Resolution. Despite some limitations and barriers to achieving transparency in the composition of drug prices in Brazil, the country has a regulatory framework and successful experiences that can contribute towards improving price transparency. The Brazilian case indicates that transparency laws, policies, and institutional capacity could help provide some additional information for policymakers. Policymakers should also consider the use of health data interoperability standards to share information on the costs and pricing of medicines at all levels.

Variation in Price of Cardiovascular and Diabetes Medicine in Indonesia, and Relationship with Quality: A Mixed Methods Study in East Java.

Lower-middle income Indonesia, the world's fourth most populous country, has struggled to contain costs in its mandatory, single-payer public health insurance system since the system's inception in 2014. Public procurement policies radically reduced prices of most medicines in public facilities and the wider market. However, professional associations and the press have questioned the quality of these low-cost, unbranded generic medicines. We collected 204 samples of four cardiovascular and one antidiabetic medicines from health facilities and retail outlets in East Java. We collected amlodipine, captopril, furosemide, simvastatin, and glibenclamide, sampling to reflect patients' likelihood of exposure to specific brands and outlets. We recorded sales prices and maximum retail prices and tested medicines for dissolution and percentage of labeled content using high-performance liquid chromatography. We conducted in-depth interviews with supply chain actors. All samples, including those provided free in public facilities, met quality specifications. Most manufacturers make both branded and unbranded medicines. Retail prices varied widely. The median ratio of price to the lowest price for an equivalent product was 5.1, and a few brands sold for over 100 times the minimum price. Prices also varied between outlets for identical products because retail pharmacies set prices to maximize profit. Because very-low-cost medicines were universally available and of good quality, we believe richer patients who chose to buy branded products effectively protected medicine quality for poorer patients in Indonesia because manufacturers cross-subsidize between branded and unbranded versions of the same medicine.

The long-term effect of generic price competition on the Hungarian statin market

BackgroundGeneric competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as “statins,” was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding “statins”.MethodsData was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor “statins” from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins.ResultsIn 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased.ConclusionsThe decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.

A comprehensive survey of cancer medicines prices, availability and affordability in Ghana.

In Ghana, prices for cancer medicines are characterized by high retail markups, forex fluctuations and high variation in prices of medicines. Most patients cannot afford the cancer medicines. There is a problem of unaffordability and limited availability of essential cancer medicines which suggests potential inequity in patient access to cancer medicines. The study objective was to assess the prices, availability, and affordability of cancer medicines in Ghana. Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost was assessed to determine the affordability. The methods developed and standardized by the World Health Organization (WHO) in collaboration with the Health Action International (HAI), was adapted and used to measure prices, availability, and affordability of cancer medicines in Ghana. The availability of cancer medicines was assessed as percentage of health facilities stocked with listed medicines. The price of cancer medicines (of different brands as well as the same medicine manufactured by different pharmaceutical industries) available in the public hospitals, private hospitals, and private pharmacies was assessed, and the percentage variation in prices was calculated. Medicine prices were compared with the Management Sciences Health's International Reference Prices to obtain a Median Price Ratio (MPR). The affordability of cancer medicines was determined using the treatment cost of a course of therapy for cancer conditions in comparison with the daily wage of the unskilled Lowest-Paid Government Worker. Overall availability of cancer medicines was very low. The availability of Lowest Priced Generic (LPG) in public hospitals, private hospitals, and private pharmacies was 46%, 22%, and 74% respectively. The availability of Originator Brand (OB) in public hospitals, private hospitals, and private pharmacies was 14%, 11%, and 23% respectively. The lowest median price [United States Dollars (USD)] for the LPG was 0.25, and the highest median price was 227.98. For the OB, the lowest median price was 0.41 and the highest median price was 1321.60. The lowest and highest adjusted MPRs of OBs and LPGs was 0.01 and 10.15 respectively. Some prices were 20.60 times more expensive. Affordability calculations showed that patients with colorectal and multiple myeloma cancer would need 2554 days wages (5286.40 USD) and 1642 days wages (3399.82 USD) respectively to afford treatment. The availability of cancer medicines was very low, and less than the WHO target of 80%. There were considerable variations in the prices of different brands of cancer medicines, and affordability remains suboptimal, as most patients cannot afford the cancer medicines. Comprehensive policies, regulations and multifaceted interventions that provides tax incentives, health insurance, and use of generics to improve cancer medicines availability, prices, and affordability, for the masses should be developed and implemented in Ghana.

Price and reimbursement of medicines when new indications are approved: the results of a survey on ISPOR Italy Rome Chapter members

Multi-indication pricing models for medicines and some international impact evidence are available in the literature. Data on the Italian context are more limited. This paper illustrates the results of a study aimed at gathering the opinion on this topic of experts, members of the ISPOR Italy Rome Chapter. The opinion was collected through a structured questionnaire, validated by two potential responders, and administered online in the period October/July 2022. There were 45 responders (20% of the members); 67% of responders work in pharmaceutical companies and 13% in consultancy firms. The remainder belongs to regulators/payers and universities. The survey highlighted a preference for (i) non-automatic models, as automatic approaches are mainly based on price cuts/discount increases in relation to an increase in volumes, (ii) an “indication-based-pricing” model (where prices are differentiated by indication through discounts/risk sharing agreements), since it is more consistent with a value-based approach, even if more complex to manage, (iii) a mix of discounts/agreements according to existing evidence. The opinion collected is consistent with the opinions available in the literature, but not consistent with the Italian trend, where, compared to the past, a blended approach is prevailing. A blended pricing envisages a renegotiation of the single price for all indications, essentially based on a change in the discount. Our hope is that in the future the experts’ opinion will be taken into consideration and that a targeted indication-based-pricing will be adopted again.

Emerging themes and factors influencing the prices of biotherapeutics

AbstractThe high prices of biotherapeutics remain an area of concern for various national and international agencies working toward developing strategies for monitoring, evaluating, and managing the prices of medicines to promote equitable access. This paper deploys a unique study design to identify emerging themes and determine the elements influencing the price of biotherapeutics specifically biosimilars. This review is based on a bibliometric and qualitative synthesis approach to generate a new line of thinking for future studies. The findings enable knowledge assimilation for policy decisions. The results indicate that while the factors like market share, market competition, and pricing policies are extensively explored by researchers, the factors such as innovation capability, product development costs, and local factors like regulatory ecosystem can be further examined as potential influencers of prices. Further, pricing frameworks and regulations designed for generic drugs cannot be replicated to estimate the prices of biotherapeutics. As a result, policymakers must take the necessary actions to construct innovative pricing frameworks for this class of products that are in conformity with national policies, regulations, market dynamics, and economics. Moreover, studies on incentives and profit margins associated with the last‐mile delivery and accessibility of high‐cost biotherapeutics are essential for their efficient adoption.

Access to essential cancer medicines for children: a comparative mixed-methods analysis of availability, price, and health-system determinants in east Africa.

Access to essential childhood cancer medicines is a core determinant of childhood cancer outcomes. Available evidence, although scarce, suggests that access to these medicines is highly variable across countries, particularly in low-income and middle-income countries, where the burden of childhood cancer is greatest. To support evidence-informed national and regional policies for improved childhood cancer outcomes, we aimed to analyse access to essential childhood cancer medicines in four east African countries-Kenya, Rwanda, Tanzania, and Uganda-by determining the availability and price of these medicines and the health system determinants of access. In this comparative analysis, we used prospective mixed-method analyses to track and analyse the availability and price of essential childhood cancer medicines, investigate contextual determinants of access to childhood cancer medicines within and across included countries, and assess the potential effects of medicine stockouts on treatment. Eight tertiary care hospitals were included, seven were public sites (Kenyatta National Hospital [KNH; Nairobi, Kenya], Jaramogi Oginga Odinga Referral and Teaching Hospital [JOORTH; Kisumu, Kenya], Moi University Teaching and Referral Hospital [MTRH; Eldoret, Kenya], Bugando Medical Centre [BMC; Mwanza, Tanzania], Muhimbili National Hospital [MNH; Dar es Salaam, Tanzania], Butaro Cancer Centre of Excellence [BCCE; Butaro Sector, Rwanda], and Uganda Cancer Institute [UCI; Kampala, Uganda]) and one was a private site (Aga Khan University Hospital [AKU; Nairobi, Kenya]). We catalogued prices and stockouts for 37 essential drugs from each of the eight study siteson the basis of 52 weeks of prospective data that was collected across sites from May 1, 2020, to Jan 31, 2022. We analysed determinants of medicine access using thematic analysis of academic literature, policy documents, and semi-structured interviews from a purposive sample of health system stakeholders. Recurrent stockouts of a wide range of cytotoxic and supportive care medicines were observed across sites, with highest mean unavailability in Kenya (JOORTH; 48·5%), Rwanda (BCCE; 39·0%), and Tanzania (BMC; 32·2%). Drugs that had frequent stockouts across at least four sites included methotrexate, bleomycin, etoposide, ifosfamide, oral morphine, and allopurinol. Average median price ratio of medicines at each site was within WHO's internationally accepted threshold for efficient procurement (median price ratio ≤1·5). The effect of stockouts on treatment was noted across most sites, with the greatest potential for treatment interruptions in patients with Hodgkin lymphoma, retinoblastoma, and acute lymphocytic leukaemia. Policy prioritisation of childhood cancers, health financing and coverage, medicine procurement and supply chain management, and health system infrastructure emerged as four prominent determinants of access when the stratified purposive sample of key informants (n=64) across all four countries (Kenya n=19, Rwanda n=15, Tanzania n=13, and Uganda n=17) was interviewed. Access to childhood cancer medicines across east Africa is marked by gaps in availability that have implications for effective treatment delivery for a range of childhood cancers. Our findings provide detailed evidence of barriers to access to childhood cancer medicine at multiple points in the pharmaceutical value chain. These data could inform national and regional policy makers to optimise cancer medicine availability and affordability as part of efforts to improve childhood cancer outcomes specific regions and internationally. American Childhood Cancer Organization, Childhood Cancer International, and the Friends of Cancer Patients Ameera Fund.

Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia.

Access to affordable, quality-assured essential medicines is crucial to reduce the burden of disease. However, one third of the world's population lacks regular access to essential medicines. The purpose of this study was to assess the availability, price, and affordability of medicines for mental disorders in Addis Ababa, Ethiopia. A cross-sectional study was done in selected pharmacies after modification of a WHO/HAI methodology developed questionnaire. Data on the availability and price of 28 lowest priced generics and originator brand essential psychotropic medicines were collected from seven public sectors, five private sectors, and seven other sectors (five Kenema Public Community Pharmacies and two Red Cross Pharmacies) in Addis Ababa between May 9 and May 31, 2022. The data were analyzed using the developed WHO/HAI workbook part I Excel sheet. Descriptive results were reported in text and table format. The overall availability of lowest-priced generics medication was 41.69%. The availability of lowest-priced generics and originator brand medication was 54.68% and 1.7% in the public pharmacies; 24.14% and 0.0% in private pharmacies; 43% and 0.0% in Red Cross Pharmacies; and 42% and 3.2% in Kenema Public Community Pharmacies. The median price ratio in the public, private, Red Cross, and Kenema Public Community pharmacies was 1.26, 3.72, 1.65, and 1.59, respectively. Most of the medications were unaffordable. A patient could be required to pay up to 73 days wages to purchase a standard treatment for 1 month. The availability of psychotropic medicines was lower than the WHO target for non-communicable diseases and most of the available medicines were unaffordable.

Critical challenges and advances in recombinant adeno-associated virus (rAAV) biomanufacturing.

Gene therapy is a promising therapeutic approach for genetic and acquired diseases nowadays. Among DNA delivery vectors, recombinant adeno-associated virus (rAAV) is one of the most effective and safest vectors used in commercial drugs and clinical trials. However, the current yield of rAAV biomanufacturing lags behind the necessary dosages for clinical and commercial use, which embodies a concentrated reflection of low productivity of rAAV from host cells, difficult scalability of the rAAV-producing bioprocess, and high levels of impurities materialized during production. Those issues directly impact the price of gene therapy medicine in the market, limiting most patients' access to gene therapy. In this context, the current practices and several critical challenges associated with rAAV gene therapy bioprocesses are reviewed, followed by a discussion of recent advances in rAAV-mediated gene therapy and other therapeutic biological fields that could improve biomanufacturing if these advances are integrated effectively into the current systems. This review aims to provide the current state-of-the-art technology and perspectives to enhance the productivity of rAAV while reducing impurities during production of rAAV.

The Scenario of Buffalo Production and Research in Bangladesh

Background: This study aimed to characterize the scenario of buffalo production in the northern part of Bangladesh and review the published scientific literature on buffalo from Bangladesh.
 Methods: The study was conducted from August to December 2022. A draft questionnaire was prepared and modified before the final one based on the study's objectives. Data were collected through personal interviews with individual respondents. In addition, the review article was collected on buffalo from Google, Google Scholar, Research Gate, Scopus, Bangladesh Journal-Online (BJO), and PubMed.
 Results: Data was collected from 1099 animals from the northern part of the Natore and Lalmonirhat districts of Bangladesh. Most of the farmers were illiterate, and the age was above 40 years. Regarding the purpose of buffalo production, 69.16% (n=83) of the farmers narrated that they are motivated to milk with calves selling. The average herd size was about 9 and consisted of indigenous and crossbred buffaloes. Most of the farmers kept their buffalo in the Bathan. The coat color was predominantly black, with brown hair. Farmers 94.16% (n=113) practice de-worming, and the frequency was thrice a year. Wallowing is performed at least once a day in the pond or river for the thermal regulation of the buffalo. Among the farmers, 67.50% (n=81) have no training in rearing buffalo. Farmers practice natural mating by their own or neighbor bull to serve the heated cow. Sometimes it’s free, or sometimes, with payment on an average of BDT 400-500 or 3.79-4.73 US dollars. In some areas, AI is being practiced in buffalo under different organizations (LAL Teer, BRAC), and the cost of AI was recorded as about BDT 600-700 or 5.68-6.63 US dollars per cow. The average daily milk yield was 3.0 liter, whereas the lactation length was recorded at 179.9±3.84 days. The major constraints were high feed price 91.66% (n=110), shortage of land 41.08% (n=51), and lack of suitable marketing facilities 50.82% (n=62). 100% of farmers stated that they need improved grass production technology and reduced feed and medicine price; 24.16% (n=29) need good quality semen. From 2004 to 2022, 51 studies were found related to buffalo, where the highest 27.45% (n=14) belonged to performance studies, and 54.90% (n=28) studies were carried out in the southern part of Bangladesh.
 Conclusion: It can be concluded that buffalo has great potential with different areas of improvement. Therefore, more research is needed from different perspectives on production, reproduction, nutrition, quality of milk/meat/products, health, and sustainability of buffalo farming in Bangladesh.

The influence of SARS-COV-2 pandemic in the pharmaceutical service in ALBANIA.

In the second year of the COVID-19 pandemic, the role of the pharmacists was confirmed as central at the territorial level. The purpose of this study was to assess knowledge, attitudes, and practices of pharmacists in Albania, critical changes in the Albanian pharmaceutical market during the COVID-19 pandemic and evaluate factors influencing the quality of the pharmaceutical service. A nationwide survey was conducted, using an online questionnaire targeting Albanian pharmacists during 2021. Most of the respondents were females (86.2%), belonged to the 30-39 age group (51.7%) and worked in community pharmacies (73%). Although most of the respondents did participate in training courses (62.8%), only about 38% of them had good knowledge about COVID-19 (score 5/8). Moreover, the level of knowledge increases the possibility to apply the rules. 65% of the pharmacists who were very afraid of getting infected with COVID -19, stated that they followed the WHO rules compared to 37 % of those who were not afraid. Regarding the medicines offered, 64% of the respondents claimed that there have been difficulties in ensuring the adequate medicines during the pandemic. Furthermore, although 61% of the pharmacists declared that the price of medicines during the pandemic has not changed, 58% of them thought that the revenues of all pharmaceutical sectors have risen. From this study it is concluded that although the pharmacists in Albania have demonstrated strength, professionality, and commitment to offer pharmaceutical service to the highest level, they faced numerous challenges during this difficult time. In the future, the pharmacist's role can be extended in the community to provide successful medical service and their collaboration within and between pharmacists and physicians is essential.

Price analysis of medicines used in general anesthesia before and after the SARS-CoV-2 pandemic: a retrospective observational study

Objectives: with the emergence of the pandemic in early 2020, there was an increase in the prices of medicines used in hospital anesthetic procedures. The main objective of this study was to assess the variations in prices of anesthetics used in general anesthesia procedures between the periods prior to and after the beginning of the SARS-CoV-2 pandemic. Methods: we investigated 105 anesthesic records of exploratory laparotomies or laparoscopic procedures performed in a private hospital in southern Brazil and analyzed the prices of medicines used in two general anesthesia techniques: total intravenous anesthesia (TIVA) and balanced anesthesia with anesthetic gases. We obtained the price of anesthetic procedures from records issued in the final trimesters of 2019, 2020, and 2021 (33, 43, and 29, respectively). Results: a statistically significant difference in prices was seen between periods for both techniques. The price of TIVA in 2019 was R$ 229.30/hour, in 2020 it was R$ 472.13/hour, and in 2021 it was R$ 247.38/hour. For balanced anesthesia, this price was R$ 66.32/hour in 2019, R$ 109.97/hour in 2020, and R$ 90.30/hour in 2021. In a post hoc analysis, significant differences were observed in the hourly prices of TIVA between 2019–2020 (p=0.01) and 2020–2021 (p=0.04); for balanced anesthesia, this was seen only in the 2019–2020 period (p=0.02). Conclusion: this study demonstrated significant increases in the mean prices of general anesthesia administered via intravenous (up to 36.36%) or inhalation (up to 89.47%) routes for exploratory laparotomies performed before and after the beginning of the SARS-CoV-2 pandemic in a private hospital in southern Brazil. However, no statistical difference in the hourly prices was observed between 2019 and 2021 for both anesthetic techniques.

Analysis of oncological drugs authorised in Spain in the last decade: association between clinical benefit and reimbursement.

Our study aimed to assess whether there was a relationship between clinical benefits and reimbursement decisions as well as the inclusion of economic evaluations in therapeutic positioning reports (IPTs) and to explore factors influencing reimbursement decisions. We analysed all anti-cancer drugs approved in Spain from 2010 to September 2022. The clinical benefit of each drug were evaluated using the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) 1.1. The characteristics of these drugs were obtained from the Spanish Agency of Medicines and Medical Devices. Reimbursement status information was obtained using BIFIMED, a web resource available in Spanish and consulted the agreements of the Interministerial Committee on Pricing of Medicines (CIPM). In total, 73 drugs were included involving 197 indications. Almost half of the indications had substantial clinical benefit (49.8% yes vs. 50.3% no). Of the 153 indications with a reimbursement decision, 61 (56.5%) reimbursed indications had substantial clinical benefit compared to 14 (31.1%) of the non-reimbursed (p < 0.01). The median gain of overall survival was 4.9months (2.8-11.2) for reimbursed indications and 2.9months (1.7-5) in non-reimbursed (p < 0.05). Only six (3%) indications had an economic evaluation in the IPT. Our study revealed that there is a relationship between substantial clinical benefit and the reimbursement decision in Spain. However, we also found that the overall survival gain was modest, and a significant proportion of the reimbursed indications had no substantial clinical benefit. Economic evaluations in IPTs are infrequent and cost-effectiveness analysis is not provided by CIPM.

Cost-Minimization Analysis of Medications Used in the Management of End-stage Renal Disease

Abstract: Aim/Background: Several branded pharmaceuticals and generic medicines are available in the market for the management of End-Stage Renal Disease (ESRD) as a supportive care, and clinicians are unaware of the cost minimization and cost consequences aspects of these medications. Thus, this study aimed to compare the prices of branded versus generic medicines for ESRD treatment and to present the cost savings with a generic alternative. Materials and Methods: A prospective observational study was conducted among ESRD patients from three different tertiary care teaching hospitals in South India. The cost of branded pharmaceuticals were determined using the most recent current index of medical specialties, while the prices of generic medicines were accessed using the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana scheme, 2022. Results: The data were collected from 385 patients with ESRD. All Jan Aushadhi generic medicines were less expensive when compared to the branded medicines. The cost of ESRD medicines accessible in India varies greatly. The greatest difference in percentage cost savings were noted with amlodipine 5 mg tab (93.03%), voglibose 0.2mg/tab (88.10%), calcium carbonate + Vitamin D3 supplements 500 mg tab (80.27%), torsemide 10 mg tab (78.01%), and hematopoietic agent, erythropoietin 2000 U/inj (75.38%). Conclusion: The haematopoietic medicines and antidiabetic insulin injections were the most expensive medicines among the study population. Our research indicates that replacing the generic medicines with the branded medicines could help in reducing the cost burden. Healthcare professionals may consider prescribing generic medicines for cost-savings. Keywords: Pharmacoeconomics, Cost minimization, End stage renal disease, Antibiotics, Insulin, Jan Aushadhi.

Resignations at Canada's drug pricing panel raise independence questions.

A member of Canada’s drug pricing regulator has resigned, stating the federal government has undermined the independence and credibility of the organization. Dalhousie University health law expert Matthew Herder’s resignation from the Patented Medicine Prices Review Board (PMPRB) comes after

Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar

BackgroundDue to the COVID-19 pandemic and political crisis, Myanmar’s health system has suspended routine services while struggling to respond to the pandemic. Many people who need continuous care, like pregnant women and people with chronic illnesses, have been facing challenges in seeking and receiving essential health services. This study explored community health seeking practices and coping mechanisms, including their views on health system stressors.MethodsThis was a cross-sectional qualitative study based on 12 in-depth-interviews with pregnant people and persons with pre-existing chronic health conditions in Yangon. Sampling was purposive, convenience-based and snowball sampling was also used. The 3-delays framework was used to understand how persons were interacting with and accessing health care services; community and health system stressors and coping mechanisms in relation to COVID-19 were also identified.ResultsFindings showed that Yangon region was the hardest hit with both the pandemic and political crisis and its health system was greatly affected. People were unable to access essential health services on time. The health facilities were not available to see patients, with serious shortages in human resources, medicines and equipment, resulting in interruption of essential routine services. The prices of medicines and consultation fees, and transportation costs, increased during this period. Limited options for accessing care were available due to travel restrictions and curfews. It became challenging to receive quality care because of unavailable public facilities and private hospitals being costly.Despite these challenges, the Myanmar people and health system have shown resilience. Cohesive and organized family support structures and extended and deep social networks played an important role in accessing health care. At times of emergency, people relied on community-based social organizations for transportation and accessing essential medicines. The health system also showed resilience through establishing new service provision options, such as teleconsultations, mobile clinics, and sharing medical advice through social media.ConclusionsThis is the first study in Myanmar to explore peoples’ perceptions on COVID-19, the health system and their healthcare experiences during political crisis. Although there is no easy way to cope with this dual hardship, the people and the health system, even in a fragile and shock-prone setting like Myanmar, stayed resilient by developing alternative pathways for seeking and providing health services.

Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique.

To tackle the increasing burden of non-communicable diseases (NCDs) and reduce premature cardiovascular (CV) mortality by a third by the year 2030, countries must achieve 80% availability of affordable essential medicines (EMs) and technologies in all health facilities. To evaluate access to EMs and diagnostics for CV diseases in Maputo City, Mozambique. Using a modified version of World Health Organization (WHO)/Health Action International (HAI) methodology, we collected data on availability and price of 14 WHO Core EMs and 35 CV EMs in all 6 public-sector hospitals, 6 private-sector hospitals, and 30 private-retail pharmacies. Data on 19 tests and 17 devices were collected from hospitals. Medicine prices were compared with international reference prices (IRPs). Medicines were considered unaffordable if the lowest paid worker had to spend more than one day's wage to purchase a monthly supply. Mean availability of CV EMs was lower than that of WHO Core EMs in both public (hospitals: 20.7% vs. 52.6%) and private sectors (retail pharmacies: 21.5% vs. 59.8%; hospitals: 22.2% vs. 50.0%). Mean availability of CV diagnostic tests and devices was lower in public (55.6% and 58.3%, respectively) compared to private sector (89.5% and 91.7%, respectively). Across WHO Core and CV EMs, the median price of lowest priced generic (LPG) and most sold generic (MSG) versions were 4.43 and 3.20 times the IRP, respectively. Relative to the IRP, median price of CV medicines was higher than that of Core EMs (LPG: 4.51 vs. 2.93). The lowest paid worker would spend 14.0 to 17.8 days' wage monthly to undergo secondary prevention. Access to CV EMs is limited in Maputo City owing to low availability and poor affordability. Public-sector hospitals are not well equipped with essential CV diagnostics. This data could inform evidence-based policies for improving access to CV care in Mozambique.

Hubungan Pengetahuan dan Sikap terhadap Pola Penggunaan Obat Tradisional untuk Swamedikasi di Masyarakat Kota Denpasar

The behavior of self-medication in Indonesian society is quite large and one of the classes of drugs that can be used for self-medication is traditional medicine. The use of traditional medicine is influenced by the knowledge and attitudes of the community. This research aims to determine the relationship between knowledge and attitudes towards patterns of use of traditional medicine for self-medication in the community in Denpasar City. The research method used was an observational analytic cross-sectional study. The location used in this study is the city of Denpasar, with the time of the study taking place in July-September 2020. The research subjects are people who live in Denpasar City aged 20-64 years who buy and use traditional medicines with a total of 400 people. Data were collected by distributing questionnaires to research subjects to measure knowledge, attitudes, and patterns of use of traditional medicines. The results obtained were the pattern of self-medicated traditional medicine in most of the community with the frequency of using drugs more than 4 times a month (23.25%), the most common complaints were headaches (32.5%), the type of traditional medicine was the branded herbal medicine class %), the effect that was felt from the use of traditional medicine was getting better (98.5%) with no side effects (87.25%). Most of the information sources of traditional medicine were from the family (50.25%). Knowledge and attitudes of the people of Denpasar city are mostly classified as high with a percentage of 67.25% for knowledge and 65.50% for attitudes. It can be concluded that there is a significant or moderate relationship between knowledge and the respective patterns of use of traditional medicines, except for the relationship between attitudes and low or weak prices of traditional medicines.

Price and affordability of key essential medicines for children in Sri Lanka, a lower-middle-income country: comparison of two national cross-sectional surveys done 8 years apart

ObjectiveTo describe the price and affordability of key essential medicines for children in the private sector in Sri Lanka in 2017/2018, and compare the findings with 2009 data.DesignNational cross-sectional descriptive...