E-DRUG: Lancet paper on medicine prices, availability, and affordability
in 36 countries
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Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices,
availability, and affordability in 36 developing and middle-income
countries: a secondary analysis. Lancet, published online December 1,
2008. DOI:10.1016/S0140-6736(08)61762-6. Abstract below
Commentary
Vasan A, Kim JY. Essential medicines pricing - reform needed. Lancet,
published online December 1, 2008. DOI:10.1016/S0140-6736(08)61763-8
Summary
Background
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.
Funding
None.
Article Outline
Introduction
Methods
WHO/HAI survey methodology
Sampling
Medicines
Data collection and analysis
Methodology of the secondary analysis
Survey inclusion criteria
Medicine selection
Data analysis
Results
Discussion
Acknowledgements
Web Extra Material
References