[e-drug] Essential medicines for chronic diseases - study

[e-drug@healthnet.org]

E-DRUG: Essential medicines for chronic diseases - study
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The availability and affordability of selected essential medicines for 
chronic diseases in six low- and middle-income countries

Bulletin of the World Health Organization 2007;85:279-288.

Shanti Mendis, Keiko Fukino, Alexandra Cameron, Richard Laing, 
Anthonio Filipe Jr, Oussama Khatib, Jerzy Leowskic & Margaret Ewen

Full text:  http://www.who.int/bulletin/volumes/85/4/06-033647.pdf

Abstract

Objective To assess the availability and affordability of medicines used 
to treat cardiovascular disease, diabetes, chronic respiratory disease 
and glaucoma and to provide palliative cancer care in six low- and 
middle-income countries. Methods A survey of the availability and price 
of 32 medicines was conducted in a representative sample of public and 
private medicine outlets in four geographically defined areas in 
Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. We analysed 
the percentage of these medicines available, the median price versus the 
international reference price (expressed as the median price ratio) and 
affordability in terms of the number of days' wages it would cost the 
lowest-paid government worker to purchase one month of treatment.

Findings In all countries < 7.5% of these 32 medicines were available in 
the public sector, except in Brazil, where 30% were available, and Sri 
Lanka, where 28% were available. Median price ratios varied 
substantially, from 0.09 for losartan in Sri Lanka to 30.44 for aspirin 
in Brazil. In the private sector in Malawi and Sri Lanka, the cost of 
innovator products (the pharmaceutical product first given marketing 
authorization) was three times more than generic medicines. One month of 
combination treatment for coronary heart disease cost 18.4 days' wages 
in Malawi, 6.1 days' wages in Nepal, 5.4 in Pakistan and 5.1 in Brazil; 
in Bangladesh the cost was 1.6 days' wages and in Sri Lanka it was 1.5. 
The cost of one month of combination treatment for asthma ranged from 
1.3 days' wages in Bangladesh to 9.2 days' wages in Malawi. The cost of 
a one-month course of intermediate-acting insulin ranged from 2.8 days' 
wages in Brazil to 19.6 in Malawi.

Conclusion Context-specific policies are required to improve access to 
essential medicines. Generic products should be promoted by educating 
professionals and consumers, by implementing appropriate policies and 
incentives, and by introducing market competition and/or price 
regulation. Improving governance and management efficiency, and 
assessing local supply options, may improve availability.  Prices could 
be reduced by improving purchasing efficiency, eliminating taxes and 
regulating mark-ups.