World Health Organization/Health Action International Research Articles

Access to quality-assured artemisinin-based combination therapy and associated factors among clients of selected private drug outlets in Uganda

BackgroundMalaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based combinations. This affects access to effective treatment increasing risk of malaria parasite resistance development and adverse drug events. This study investigated access to quality-assured artemisinin-based combination therapy (QAACT) medicines among clients of selected private drug-outlets in Uganda.MethodsThis was a cross sectional study where exit interviews were conducted among clients of private drug outlets in low and high malaria transmission settings in Uganda. This study adapted the World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance.ResultsA total of 1114 exit interviews were conducted among systematically sampled drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an artemisinin-based combination anti-malarial. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained anti-malarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a QAACT. Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing a QAACT anti-malarial among drug outlet clients include type of drug outlet visited (aPR = 0.74; 95%CI 0.6, 0.91), not obtaining full dose (3-day treatment) of ACT (aPR = 0.49; 95%CI 0.33, 0.73), not finding the ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49), post-primary education (aPR = 1.29; 95%CI 1.07,1.56), business occupation (aPR = 1.24; 95%CI 1.02,1.50) and not having a prescription (aPR = 0.76; 95%CI 0.63, 0.92).ConclusionLess than a third of the private drug outlet clients obtained a QAACT for management of malaria symptoms. Individuals who did not find artemisinin-based combinations to be expensive were more likely to obtain a QAACT anti-malarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of QAACT anti-malarial agents under the current private sector copayment mechanism.

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

BackgroundDiabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia’s public and private medicine outlets with respect to availability and affordability parameters. MethodsA cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days’ wages required by the lowest paid government worker (LPGW) to purchase a one month’s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.ResultsAcross all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO’s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month’s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.ConclusionsThere are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Copayment mechanism in selected districts of Uganda: Availability, market share and price of quality assured artemisinin-based combination therapies in private drug outlets.

Malaria remains one of the leading causes of morbidity, and mortality in Uganda. A large proportion of malaria symptomatic patients seek healthcare in private sector. However, availability and affordability are major barriers to access to effective treatment. The private sector copayment mechanism in Uganda aims to increase availability and affordability of antimalarial agents. Our study assessed availability, price, and market share of quality assured artemisinin-based combination therapies (QAACTs) in private drug outlets in selected districts during the implementation of copayment mechanism. This was a cross-sectional survey of anti-malarial agents in private drug outlets in in selected moderate-to-high (Tororo, and Apac districts) and low (Kabale and Mbarara districts) malaria transmission settings. Following the World Health Organization/Health Action International (WHO/HAI) criteria, an audit of the antimalarial agents was done using a checklist to determine availability, price, and market share of QAACTs. Data were entered in Epi-data and analyzed in STATA ver 14.0 at 95% confidence level. A total of twenty-eight (28) private drug outlets (pharmacies and drug shops) were included in the survey. One in seven (20/144: 95%CI: 9.1, 20.6) of the antimalarial agents in private drug outlets were quality assured artemisinin-based combination therapies (QAACT). Artemether-lumefantrine (AL), 8.9% (11/124) and Artesunate-Amodiaquine (AQ), 7.3% (9/124) were the only QAACTs present in the drug outlets at the time of the survey. The majority, 86.1%% (124/144) of antimalarial agents present in stock in the drug outlets were artemisinin based. The most common, 38.9% (56/144) ACT in the drug outlets was Dihydroartemisinin-Piperaquine (DHP). Most, 69.4% (100/144) of the antimalarial agents were in high malaria transmission settings. The cost of ACT antimalarial agents is high in the country, USD 1.4 (Artemether-Lumefantrine, AL), USD 2.4 (Dihydroartemisinin-Piperaquine, DP), the first line and second-line agents respectively for treatment of uncomplicated malaria in Uganda. There was a statistically significant difference between the dispensing price of 'Green leaf' ACTs (QAACT) and the recommended price (p<0.001). Predictors of availability of QAACT in private drug outlets include pharmacy drug outlet (aPR:0.4; 95%CI: 0.2, 0.9) and dispensing price more than 3000UGX (USD 0.83) (aPR: 0.4, 95%CI: 0.1, 0.51). Quality assured artemisinin-based combination therapies (QAACTs) are not common in private drug outlets in selected districts in Uganda. All the drug outlets had at least one ACT antimalarial agent present on the day of the survey. The dispensing price of QAACTs was significantly higher than the recommended markup price. There is need for awareness creation, surveillance, and monitoring of the implementation of Copayment mechanism in the country.

Evaluating the affordability of asthma, chronic obstructive pulmonary disease, and cystic fibrosis medicines in a middle-income country

BackgroundA heavy financial burden is imposed on patients suffering from chronic diseases due to medicine out-of-pocket payments.ObjectivesThis study focuses on assessing the affordability of medications used for chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) in Iran, specifically on the category R medicines listed in the 2017 Iran drug list (IDL) that are used for the treatment of these diseases, based on the anatomical therapeutic chemical (ATC) drug code.MethodsThe affordability of medicines in mono and combination therapy approaches was assessed in CRDs using the World Health Organization/Health Action International (WHO/HAI) methodology. Accordingly, if out-of-pocket payment for 30-days of pharmacotherapy exceeds one day for the lowest-paid unskilled government worker (LPGW), it’s considered non-affordable.ResultsBased on the monotherapy approach, our finding demonstrates that all generic medicines of category R were affordable. However, branded drugs such as Symbicort®, Pulmicort Respules®, Flusalmex®, Seretide®, Fluticort Plus®, Seroflo®, and Salmeflo® cost between 1.2 and 2.5 days’ wage of LPGW and considered unaffordable despite 70% insurance coverage. Moreover, based on the affordability ratio in the combination therapy approach, all medicines used in asthma, COPD, and CF patients with mild respiratory problems are affordable except omalizumab (inj), which is non-affordable due to its high price and no insurance coverage.ConclusionResults showed that the existing insurance coverage does not protect households from hardship, so more considerations are needed such as different insurance schedules and patient support programs.

A 5-year Tracer Medicines Availability Trend in the Obstetrics Gynecology Department of a Teaching Hospital

Background Medications are indispensable in women’s healthcare. Yet, there are barriers to their availability. Tracer medicines (TMs), as a representative subset of Essential Medicines (EMs) was pioneered by the World Health Organization (WHO) with a 100% expected availability benchmark. Managing the availability of TMs is a determinant of pharmacy performance, access to medicines and healthcare quality. There is paucity of studies on the availability of TMs in an obstetrics and Gynecology unit of a hospital. Aim The aim of the study was to assess availability of TMs in in an Obstetrics Gynecology (O &amp;G) Department of a Teaching Hospital. Methodology The study was conducted on the 31st of January each year from 2019 to 2023 at the O &amp; G department of Korle-Bu Teaching Hospital. Data collected were analyzed using a modified WHO/ Health Action International (WHO/HAI) methodology to review TM availability only. The original WHO/HAI methodology reviews TM prices, availability and affordability. TM is available if physically existent and unexpired on the day of survey. Results At the O &amp; G, there are 21 molecules that are classified as TM. For the years 2020, 2021 and 2023, all 21 molecules were 100% available on the day of the survey. In 2019 and 2022, 85.7% and 90.5% availability were recorded. Specific TMs that recorded some stock outs were Injections Ephedrine 30mg, Injection Magnesium sulphate 50%, Injection pethidine 100mg, Injection Vitamin K 1mg, as well as Tetracycline eye ointment. Conclusion Availability of TMs for women’s healthcare was less than 100% expected benchmark on some occasions. Policies are needed to improve availability, through an improved management of tracer medicines. A hospital-wide survey of more specialties is desirable for a wider view of access to TMs. Keywords: Tracer Medicine, Availability, expected benchmark,

A Cross-Sectional Study of Price and Affordability of Drugs for Rare Diseases in Shandong Province, China.

Objective: The affordability of rare disease drugs has become a social issue that cannot be ignored. This study aims to evaluate the current price and affordability of rare disease drugs in China, with evidence from Shandong province. Methods: Data on prices and affordability of 50 drugs for 22 rare diseases were collected from secondary and tertiary public hospitals in Shandong Province, using an adaptation of the World Health Organization/Health Action International (WHO/HAI) methodology. Prices were measured as Median Price Ratios (MPRs). Affordability was measured as days of daily per capita disposable income required for the cost of one month’s treatment. Results: Out of the 50 rare disease drugs, 11 drugs had MSH reference prices and 34 had PBS reference prices. Median prices of 11 drugs were higher than MSH reference prices (median 1.33), and median prices of 34 drugs were higher that Australian PBS prices (median 1.97). Thirty-six (72.00%) and forty-four (88.00%) drugs were unaffordable for urban and rural residents, respectively. Thirty-four (68.00%) and thirty-eight (76.00%) drugs were unaffordable for urban and rural residents even after reimbursement by the health insurance schemes of China, respectively. Conclusions: The affordability of some rare disease drugs remained poor with their relatively high prices in Shandong Province. Sustainable mechanisms are needed to reduce the price of rare disease drugs and to improve the affordability of rare disease patients.

Accessibility of Essential Medicines for Children in Sichuan Province of China: A Cross-Sectional Study.

Background: Essential medicines for children are those medicines that satisfy the priority health care needs of children. Access to essential medicines for children is a big challenge, particularly in low- and middle-income countries. Our study aimed to assess the accessibility of essential medicines for children in public sector in Sichuan Province of China, based on availability, affordability, and price. Methods: We adopted the modified World Health Organization/Health Action International (WHO/HAI) standardization methodology to measure the availability, affordability, and prices of 30 essential medicines for children in 20 public hospitals in nine regions of the Sichuan Province, China. Availability was expressed as the percentage of public medicine outlets that stocked surveyed medicines on the day of data collection, and prices were expressed as median price ratio (MPR). Affordability was assessed as the number of Sichuan Province’s daily wages required for the lowest-paid government unskilled worker (11.03 USD per day) to purchase one standard treatment of an acute disease or treatment for chronic disease for a month. Results: The mean availability of originator brands (OBs) and lowest priced generics (LPGs) were 9.7 and 46.5% in public sector. MPRs of only 3 OBs could be calculated, ranging from 0.55 to 13.37. MPRs of 18 LPGs ranged from 0.07 to 25.05. Among them, 2 OBs and 11 LPGs were priced at more than 1.5 times their international reference prices (IRPs) in public sector, most of which were injections. Except for cefazolin injection and ceftriaxone injection, most LPGs were affordable for the treatment of childhood diseases in public sector, as they each cost one or less than the daily wage for the lowest-paid unskilled government worker. Conclusions: Although the availability of LPGs for children was higher than OBs in public sector, the availability of children’s essential medicines was low in surveyed public sector in Sichuan Province, which was similar to previous studies in other provinces of China. The price of most medicines surveyed was higher than their IRPs in surveyed public sector, especially for some injections. The affordability of most surveyed LPGs was reasonable in surveyed public sector, except for ceftriaxone injection and cefazolin injection.

Wide Cost Variations Observed in Antibiotics and Analgesics Prescribed for Dental Care in India: A Price and Affordability Analysis.

IntroductionWith high prevalence rates across the population, dental pain is the most common symptom that drives a patient to visit the dentist. Dentists prescribe analgesics and antibiotic prophylaxis apart from routine dental treatments. The increasing costs of medications are a major factor that adds to the financial burden of patients seeking oral care.MethodsA list of antibiotics and analgesics recommended by the American Dental Association for dental pain, swelling, and post-procedural pain management was analyzed for the cost variation and cost ratio. The affordability was calculated by the World Health Organization/Health Action International (WHO-HAI) methodology. The most expensive and the least expensive brands of all drug regimens were compared.ResultsWide cost variations were observed between the different brands of antibiotics and analgesics. The highest cost variation was found in ampicillin 500 mg injection (13579.2%). In the affordability analysis; when the most expensive brands were analyzed, the lowest-paid unskilled worker had to lose 2.1 days of wages to afford the drug regimen. The price range was widest for injection ampicillin 500 mg (Rs. 4.24-580.0) and lowest for tablet ibuprofen 400 mg (Rs. 0.7-1.6). ConclusionDental surgeons need to be well aware of the pharmacoeconomics behind medications that directly decides the affordability of treatments. Careful selection of drugs by the dentists considering their quality, availability, and costs is of pivotal importance. Prescribing generic medications and increasing the availability of drugs in public health sectors can help provide cost-effective dental care for all.

Availability, affordability and price components of insulin products in different-level hospital pharmacies: Evidence from two cross-sectional surveys in Nanjing, China.

The essential medicine--insulin cannot be easily accessed and afforded in many countries. To help address this issue, we evaluated the availability, affordability and price of insulin products in Nanjing, eastern China. Two cross-sectional studies were conducted in 2016 and 2018. A total of 56 hospital pharmacies were sampled, using a simplified and adapted World Health Organization/Health Action International (WHO/HAI) methodology. Prices were expressed as Median Price Ratios (MPRs) to Australian Pharmaceutical Benefit Scheme (PBS) prices. In addition, we investigated the price components of seven selected insulin products as a case study before and after the Online Centralized Procurement Policy for Hospital Drugs in May, 2018. Affordability was presented as the number of daily wages of the lowest paid unskilled government worker (LPGW) required to purchase 1000IU of insulin based on the average courses of treatment, approximately 30 days' treatment. The availability of insulin products was very high in secondary hospitals and tertiary hospitals both in 2016 and 2018, but in community hospitals was very low. In 2018, the availability of prandial insulin products showed fluctuation compared to 2016. The availability of pre-mixed human insulin products was over 95% overall, and also very high (80%) in community hospitals in 2018. The prices of insulin products were much lower than PBS prices of Australian in this study, with the MPRs less than 1 (0.32 to 0.71 in 2016 vs. 0.30 to 0.68 in 2018) for all insulin types. But insulin products in Nanjing in 2016 and 2018 were considered unaffordable, because the number of daily wages of the LPGW needed to purchase for the 30 days treatment of insulin products ranged from 2.26 to 8.49 in 2016 and 1.88 to 7.09 in 2018. The manufacturers' selling price contributed the main part (74.15% to 77.70% before and 74.86% to 91.51% after the implementation of the bidding policy) of the price components of target insulin brands. The availability of insulin products was high in secondary hospitals and tertiary hospitals, but lower in community hospitals. However, the affordability in community hospitals was better than other hospitals, but the insulin products were still unaffordable for patients on low incomes. Further improvements of the availability accessibility and affordability of medicines in advancing health insurance policies and lowering drug prices should be put forward.

Trends in access to anti\u2010malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first\u2010line anti\u2010malarials and diagnostics between 2007 and 2018

BackgroundMalaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018.MethodsCross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices, and affordability of ACT medicines in private retail outlets. A minimum of 30 outlets were surveyed per year as prescribed by the standardized methodology co-developed by the WHO and Health Action International. Availability, patient prices, and affordability of malaria rapid diagnostic tests (RDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the artemisinin-based combinations and RDTs was calculated in US dollars (USD). Affordability was assessed by computing the number of days’ wages the lowest-paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria.ResultsAvailability of artemether/lumefantrine (A/L), the first-line ACT medicine, increased from 85 to100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. The affordability of ACT medicines and RDTs was below one day’s wages for LPGW.ConclusionsAvailability of ACT medicines in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider the inclusion of diagnostic kits in the subsidy programme.

Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen

Background: Medicine and medical supplies are often in short supply in countries suffering from the scourge of conflict. Effective medicine supply policies are lacking in many low- and middle-income countries (LMICs), particularly during conflict. This study aimed to assess the availability of essential medicines in both the public and private healthcare sectors. Methods: The study was conducted by administering a survey from November 2017 to February 2018 using the World Health Organization/Health Action International (WHO/HAI) guidelines and methodology. Thirty healthcare facilities in thirteen districts from three governorates in Yemen were included in the assessment of thirty essential medicines. The results were reported as frequencies and percentages of outlets with available medicines on the day of data collection. Results: A set of 30 vital and essential medicines were selected from the list of essential medicines that are used in healthcare centers in Yemen to treat prevalent diseases. In general, only 52.8% of the selected medicines were available in public and private healthcare settings. The distribution and availability of medicines in the three governorates were approximately equal. The availability of medicines was better in the private healthcare settings, specifically 73.3% in private hospitals and approximately 79.7% in private pharmacies. Conclusions: The availability of essential medicines during this state of conflict in three governorates in Yemen is low, in both public and private hospitals and healthcare centers. Many of the medications that were not available are used to treat chronic illnesses.

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines.

The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.

The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries.

Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices, and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries. Methods: Data on affordability, availability, and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organization/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal, and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of innovator brand (IB) and lowest priced generic (LPG) of diabetes medicines by WHO regional groupings and by country level. Results: Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-month’s supply of IB of insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p = 0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of insulin 100 IU/ml and metformin 500 mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively. Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.

Insulin: prices, availability, and affordability in public and private Peruvian pharmaciesPreço, disponibilidade e acessibilidade à insulina em farmácias públicas e privadas no Peru

RESUMENObjetive.Medir el precio, disponibilidad y asequibilidad de insulina y metformina, como comparador, en farmacias públicas y privadas en seis regiones del Perú.Métodos.Estudio transversal con uso de la metodología adaptada de la Organización Mundial de la Salud/Acción Internacional para la Salud (OMS/AIS). Se encuestaron farmacias públicas y privadas de seis regiones del Perú. Se recolectaron datos de disponibilidad y precio de insulina (todos los tipos) y metformina en presentación de 850 mg. La disponibilidad se expresa en porcentajes y los precios se reportan en medianas. La asequibilidad se define como el número de días que debe laborar una persona con el salario mínimo para cubrir el costo de un mes de tratamiento.Resultados.La disponibilidad en farmacias públicas es de 63,2% para insulina regular y 68,4% para isófana-NPH, pero se observaron diferencias de disponibilidad entre los niveles de atención y entre las regiones. En farmacias privadas, la variedad de insulina es mayor, pero la disponibilidad es menor del 11%. La mediana de precios para la insulina humana en farmacias privadas fue entre tres a cuatro veces mayor que en farmacias públicas. En comparación, la disponibilidad de metformina alcanza 89,5% en farmacias públicas y 77,7% en privadas. La asequibilidad en farmacias públicas para un mes de tratamiento con insulina humana o metformina genérica es menor a lo percibido por un día laborable.Conclusiones.El precio de insulinas humanas y de metformina genérica en farmacias públicas es asequible. Sin embargo, se necesitan esfuerzos para mejorar su disponibilidad en las regiones y los niveles de atención.

Access and Affordability of Medicines in Malaysia: Need for a National Pricing Policy.

High medicines prices are a barrier to medicines access, and their impact is greater in developing countries. This study assessed the availability, prices and affordability of medicines in public and private sectors in Malaysia to understand the pharmaceutical environment and guide policy recommendations. This nationwide cross-sectional study adapted the World Health Organization/Health Action International (WHO/HAI) methodology. A total of 87 premises from both public and private sectors participated in this study. Data on 50 medicines were collected to analyze availability, prices and affordability. Medicine prices were compared against the international reference prices (IRPs), and affordability was assessed by daily income level. In the public sector, the average availability of generics (74.8%) was higher than that of the originator brand name products (19.4%). However, in the private sector, the availability of originator brands was higher (52.2%) than generics (49.1%). Procurement prices in the public sector were up to 1.5 times the IRPs, but up to 8.4 times in the private sector. The study also observed large price variation across medicines in the private sector. Median retail mark-ups in private hospitals (generics 166.9%; originators 51.0%) were higher than in retail pharmacies (generics 94.7%; originators 22.4%). Generics were generally affordable, but originator brands were unaffordable. Current policies on generic medicines need to be strengthened to improve the availability and use of generics in the country. High medicine prices and large price variation in the current free market suggest that coherent pricing policies and regulations are needed to safeguard the accessibility and affordability of medicines for the people.

Availability, Price, and Affordability of Essential Medicines to Manage Noncommunicable Diseases: A National Survey From Nepal.

The aim of this study was to evaluate the availability, price, and affordability of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional survey was conducted in Nepal in 2015 using World Health Organization/Health Action International (WHO/HAI) methodology. We collected data on the availability and price of 60 essential NCD medicines from medicine distribution outlets in both the public and private health care sectors in 6 regions. Essential NCD medicines were more available in the private sector (78%) than the public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets) and streptokinase injections were the most expensive (NPR 2200/vial) drugs. There was no significant difference (P > .05) in availability and affordability of essential NCD medicines across the 6 survey areas. Treating selected NCD conditions with medicines was generally affordable, with 1 month of treatment costing no more than a day’s wage of the lowest paid unskilled government worker. The lower availability of NCD medicines in the public sector limits the effectiveness of the government’s policy of providing free health services at public facilities. Although NCD medicines were generally affordable, future health policy should aim to ensure improved equitable access to NCD medicines, particularly in public facilities.

The availability, price and affordability of antidiabetic drugs in Hubei province, China.

Based on the high prevalence and undiagnosed rate of diabetes mellitus in China in recent years, the aim of this work was to evaluate the availability, price and affordability of pharmacotherapy for diabetes in public hospitals in Hubei province, China. In 2016, a cross-sectional survey was conducted using World Health Organization/Health Action International (WHO/HAI) methodology. Information on the availability and prices of 20 antidiabetic drugs was collected from 34 public hospitals representing three levels of care. Of the 20 antidiabetic drugs, 70.6% were below 50% availability. Total availability of the 20 drugs was higher in secondary and tertiary hospitals than in primary hospitals. All three hospital levels had higher availability of essential than non-essential antidiabetic medicines. The median markup ratios of originator brands (OBs) and lowest-price generics (LPGs) were 15.6% and 2.1%, respectively. The median potential saving ratio of using generics was 31.3%. Overall, the median affordability of 31 antidiabetic drugs ranged from 1.2 to 8.5 days of disposable income for residents with three income levels. After insurance reimbursement, the increase in the proportion of affordable drugs in urban and rural areas averaged 35.5% and 12.9%, respectively. The proportion of drugs with low availability and low affordability dropped from 54.8% to 38.7%. However, 41.7% of urban diabetic patients and 74.0% of rural diabetic patients remained unable to afford the drugs surveyed. Higher income and generic substitution are factors facilitating affordability. In Hubei province, the overall availability of 20 antidiabetic drugs was low, especially in primary hospitals. The affordability of most drugs surveyed was also low. Current health insurance can greatly improve affordability for urban residents with middle or high income. Policy changes should focus on the supply, pricing and clinical use of antidiabetic drugs and special health insurance plan for low income population with diabetes.

Pricing and components analysis of some key essential pediatric medicine in Odisha state.

Objective:Study highlighting prices, i.e., the patients actually pay at ground level is important for interventions such as alternate procurement schemes or to expedite regulatory assessment of essential medicines for children. The present study was undertaken to study pricing and component analysis of few key essential medicines in Odisha state.Methodology:Six child-specific medicines of different formulations were selected based on use in different disease condition and having widest pricing variation. Data were collected, entered, and analyzed in the price components data collection form of the World Health Organization-Health Action International (WHO-HAI) 2007 Workbook version 5 – Part II provided as part of the WHO/HAI methodology. The analysis includes the cumulative percent markup, total cumulative percent markup, and percent contribution of individual components to the final medicine price in both public and private sector of Odisha state.Results:Add-on costs such as taxes, wholesale, and retail markups contribute substantially to the final price of medicines in private sector, particularly for branded-generic products. The largest contributor to add-on costs is at the level of retailer shop.Conclusion:Policy should be framed to achieve a greater transparency and uniformity of the pricing of medicines at different health sectors of Odisha.

Challenges constraining access to insulin in the private-sector market of Delhi, India

ObjectiveIndia's majority of patients—including those living with diabetes—seek healthcare in the private sector through out-of-pocket (OOP) payments. We studied access to insulin in the private-sector market of Delhi state, India.MethodsA...

A survey of the availability, prices and affordability of essential medicines in Jiangsu Province, China

BackgroundField surveys conducted in China before the implementation of the essential medicine policy showed that Chinese individuals faced less access to essential medicines. This paper aims to evaluate the availability, prices and affordability of essential medicines in Jiangsu Province, China after the implementation of the policy in 2009.MethodsA cross-sectional survey was conducted in Jiangsu in 2013 using the World Health Organization/Health Action International (WHO/HAI) methodology. Data on the availability and prices of 50 essential medicines were collected from the public and private healthcare sectors.ResultsThe mean availabilities of innovator brands and lowest priced generics (LPGs) were 11.5 % and 100 % in primary healthcare facilities, 36.8 % and 32.6 % in the secondary and tertiary sectors, and 18.7 % and 42.9 % in the private sector, respectively. The median price ratios (MPRs) were 1.26 to 2.05 for generics and 3.76 to 27.22 for innovator brands. Treating ten common diseases with LPGs was generally affordable, whereas treatment with IBs was less affordable.ConclusionsThe high availability of LPGs at primary healthcare facilities reflects the success of the essential medicine policy, while the low availability in secondary and tertiary levels and in private pharmacies reflects a failure to implement the policy in these levels. The health policy should be fully developed and enforced at the secondary and tertiary levels and in the private sector to ensure equitable access to health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1008-8) contains supplementary material, which is available to authorized users.