E-DRUG: New paper about Price, Availability and Affordability of Medicines in the Philippines
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E-Druggers,
I have just read an article in the International Journal of Environmental Research and Public Health about Price Availability and Affordability of Medicines in the Philippines. The article is in a journal that I do not know called the International Journal of Environmental Research and Public Health.
They published a special issue that was edited by Zaheer-Ud-Din Babar who also edits the JOPP.
https://www.mdpi.com/journal/ijerph/special_issues/pharmaceutical_research
The article was by Lambojon, K.; Chang, J.; Saeed, A.; Hayat, K.; Li, P.; Jiang, M.; Atif, N.; Desalegn, G.K.; Khan, F.U.; Fang, Y. and is titled Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines. Int. J. Environ. Res. Public Health 2020, 17, 5242. https://www.mdpi.com/1660-4601/17/14/5242
All of the ten authors give their affiliation at Xi�an Jiaotong University, Xi�an 710061, China.
I wondered how so many researchers from China were doing research in the Philippines so I wrote to them and discovered that the lead author, Krizzia Lambojon, is a scholar from the Philippines, who is currently doing her masters here in Xi Ban Jiaotong University under the supervision of Yu Feng. She was the principal investigator of the study and facilitated the data gathering while she was in the Philippines and the remainder of the China based team supported her focus of conducting research about her home country. This is an amazing piece of work for a Masters level student!
I think that it is an excellent article that could serve as a model for others looking to do such research on Price Availability and Affordability of NCD Medicines.. There is much that I like about it. I particularly like the use of the Figure 2 that was originally developed by Margaret Ewen for her paper (Baseline assessment of WHO's target for essential NCD medicines. This figure combines affordability and availability and reports which NCD medicines are more than 80% available and cost less than one days wages. I think this form of analysis should become the new standard for reporting NCD medicine price and availability.
I was pleased that the authors said 'In the current study, the median price ratio (MPR) was not calculated due to the outdated 2015 MSH standard price reference.' It is a real shame on MSH that they have not maintained the Price Index. I was pleased with how they described the devolution impact on access to medicines in the Philippines. Especially as other countries such as Kenya are going in the same direction!
I was surprised that the authors did not collect the prices and availability of a few acute medicines such as antibiotics or analgesics. I always find these to be useful comparators as usually they are more available and usually more affordable.
It was great that the authors credited Marg Ewen from HAI with providing support and guidance for the research team. She does this for so many groups and frequently does not get acknowledged.
There is much that could be discussed about the paper. They chose 50 NCD medicines to survey. Their criteria for selection seemed reasonable and allowed them to analyze the effect of a regulation to exempt VAT on Diabetes, cholesterol and hypertensive medicines. As I mentioned above I would have liked to see them collect a few acute comparator medicines. For data collection they used a form based on the WHO/HAI template and they used the WHO/HAI workbook with double entry and auto checker.
As mentioned above they were not able to compare the prices with an International Reference Price due to the failure of MSH to maintain their invaluable Drug Price Indicator Guide. So they reported actual prices and were able to compare prices of originator and Lowest Price Generics and between public and private sectors. Data was collected from three regions from 36 public and 42 private facilities. They did not undertake a price components study. This is more difficult to do and a previous study by Ball and Tisocki had studied this issue in the Philippines.
The results were not surprising but still were disappointing. The public sector availability for Lowest Priced generics (LPG) medicines was only 25% while the private sector was just a little better at 35.4% for LPGs. The prices of the medicines were generally lower (though not always) in the public sector and LPGs were cheaper than originators. Only seven medicines (3 public sector and 4 private sector) achieved the 80% availability at a cost of less than a daye$B!Ge(Bs wage!
The discussion section of the paper is long and I think highlights a number of key points. One of their first points is'The findings highlight the need for a shift of focus in policies from price reduction to improved availability of essential medicines for NCDs.' To me this is a key point when studying access to NCD medicines! Another strength of the discussion is that they compare their findings with similar surveys undertaken in China, Malaysia, Pakistan and previously in the Philippines.
The study demonstrates that with minor adaptations the WHO/HAI methodology can still be used. Masters level students can undertake such surveys and the results can demonstrate the challenges that patients with NCDs may face accessing their medicines!
So my conclusion is that this is a well done study, written up in a clear and understandable fashion and can serve as a model for anyone else who wishes to do such a study in their country!
My congratulations to all involved!
Richard Laing
Retired Professor, Department of Global Health
Boston University School of Public Health,
E mail richardl@bu.edu