E-DRUG: New article about medicine prices and availability in China
----------------------------------------------------------------------
Hi E-Druggers,
I am pleased to highlight what I think is an important new article about using the WHO/HAI Medicine Pricing and Availability in China.
This original article was published in Frontiers in Pharmacology, section Pharmaceutical Medicine and Outcomes Research. The title of the article is Evaluating price, availability of essential medicines in China: a mixed cross-sectional and longitudinal study. The authors are Caijun Yang, Shuchen Hu, Dan Ye, Minghuan Jiang, Zaheer-Ud-Din Babar, Yu Fang
To view the online publication, please paste this URL into your browser http://journal.frontiersin.org/article/10.3389/fphar.2020.602421/full?&utm_source=Email_to_rerev_&utm_medium=Email&utm_content=T1_11.5e4_reviewer&utm_campaign=Email_publication&journalName=Frontiers_in_Pharmacology&id=602421
The citation for the article is Caijun Yang, Shuchen Hu, Dan Ye, Minghuan Jiang, Zaheer-Ud-Din Babar, Yu Fang (2020). Evaluating price, availability of essential medicines in China: a mixed cross-sectional and longitudinal study . Front. Pharmacol. 11:01781. doi: 10.3389/fphar.2020.602421
The abstract reads:
Objectives: To evaluate the price and availability of medicines in China.
Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018.
Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29-32.87%) and private sectors (13.5-43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80-3.02) and for originator brands (OBs) was much higher (9.1-12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector.
Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.
I first read this article when I was asked by the Frontiers Pharmacology Editorial office to review the paper. While I get asked to review many papers this experience was rather different in that the method used by this journal is rather unusual! They encourage communicating with the authors and provide other reviewers comments to comment on. Altogether a better experience and more constructive.
The paper reports on surveys undertaken in five of China's 31 provinces. They used the standard WHO/HAI medicines availability and pricing survey method though they adapted their selection of municipal regions by stratifying by GDP per capita ranking. They surveyed 48 medicines 12 from the WHO core and 36 others. Additionally they reported on four surveys from 2010, 2012, 2014 and 2018 in Shaanxi province. These repeated surveys occurred in the same cities and 31 of the 48 medicines surveyed were the same and so allowed for comparisons over time. The paper describes in detail how Data Quality Control was assured. For anyone planning to do such a medicine pricing and availability survey this section is well worth reading.
The data analysis categorized availability into different categories and used the MSH 2015 International Reference Prices. The fact that this important reference has not been updated is a shame but for a 2018 survey using it was reasonable. We can only hope that MSH updates it soon!
The results show that there is generally low availability in the public and private sectors with lower availability of Originator Brands except in one province Yunnan where Originator Brands were most available. There was considerable variation between provinces for the different categories of medicines.
For pricing the Median Price Ratios (MPR) for generics in the public sector varied from 1.8 to 2.55 which is considerably less than the WHO NCD target of 4.0. For the few Originator medicines available in the public sector the MPRs varied from 10.22 to 12.65 which is what I would have expected. But what did intrigue me is that there was no difference between provinces for prices in the public sector. In the private sector the MPRs for generics were low (1.66 to 3.02) and the MPRs for Originators the MPRs were similar but lower than the prices in the public sector. There were significant differences in the MPRs between provinces for the private sector. What these figures tell me is that the market for both generic and originator medicines in China is competitive and I would guess that any attempt to reduce prices further might lead to even worse availability for generic medicines.
The longitudinal data from Shaanxi province showed that since 2010 there had not been an improvement in availability in the public or private sectors either for generics or originator medicines. For prices the authors reported prices in the local currency adjusted for inflation to 2010 prices. This showed that in the public sector there had been about a 20% -22% decrease over the eight years both for generics and originators. In the private sector, prices also generally went down for originators though there was an 11% increase for generics.
The discussion section addresses some of the policy changes occurring in China. What surprised me was that despite the dramatic economic growth of China during this period that availability remains generally poor especially in the public sector. Prices for generics in the public and private sectors were reasonable but originators were high priced in both public and private sectors.
The repeated surveys from Shaanxi province were interesting. If the policy changes had made a big difference these surveys would have detected the effect of these policies.
So my conclusion from reading this paper is that the WHO/HAI methodology for measuring medicine availability and prices remains a useful tool. For any government planning to make a policy change doing such a survey before and after the policy is implemented would be very useful to evaluate the effect of the policy change. For researchers who may be considering doing such a survey this is a very useful resource that should be studied carefully when planning your survey. There is also a useful reference list. For policy makers this is a cautionary paper. Despite China’s stated policies and enormous investments in their health sector it can be difficult to make a major difference in improving access to medicines.
I do congratulate all of the authors and the many colleagues across China who collected all of this data. I do hope that they will continue doing such surveys and reporting their results as they have done in this article.
Richard Laing
Retired Professor, Department of Global Health
Boston University School of Public Health,
Tel 617 435 7860 (Mobile)
E mail richardl@bu.edu