Download - Ntabeko Mpanza Richard Laing
August 27th 2008 1
Availability, Pricing and Affordability of Asthma Medicines 2001-2006Presentation for Meeting on Availability, Pricing and Affordability of NCD Medicines WHO Geneva
Ntabeko Mpanza Richard Laing
August 27th 2008 2
Outline
Introduction & Background Methodology Results
Availability Pricing Affordability
Discussion & Policy options
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Introduction & Background Asthma was the 25th leading cause of disability
adjusted life years lost worldwide in 2001, estimated to be about 15 million DALYs per year
Beclomethasone inhalers and salbutamol inhalers are on the WHO EML.
Recent paper in Allergy by N. Ait-Khaled, D. A. Enarson, K. Bissell, N. E. Billo. Access to inhaled corticosteroids is key to improving quality of care for asthma in developing countries.
However, many patients have difficulty accessing treatment; it is a challenge for them to get their medication and so, levels of uncontrolled asthma cases remain high.
Aim: Secondary analysis of price, availability and affordability of CVD medicines in 36 developing countries that have undertaken WHO/HAI surveys
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Methodology
WHO/HAI data Standardized data collection Prices as Median Price Ratios (MPRs) Medicines:
Salbutamol 0.1mg/dose 200 dose inhalant Beclomethasone 50ug/dose 200 dose inhalant
Secondary analysis Adjustments for inflation and purchasing power Analysis by World Bank Income Groups and WHO
regions.
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Country list (48 surveys in 35 countries)
Low incomeChadEthiopia (2004)Ghana (2004)India-Chennai (2004)India-Haryana (2004)India-Karnataka (2004)India-Maharashtra 12 districts (2004)India-Maharashtra 4 regions (2005)India-Rajasthan (2003)India-West BengalKenya (2004)Kyrgyzstan (2005)Mali (2004)Mongolia (2004)Nigeria (2004)Pakistan (2004)Sudan-Gadarif (2006)Sudan-Khartoum (2005)Sudan-Kordofan (2006)Tajikistan (2005)Tanzania (2004)Uganda (2004)
Uzbekistan (2004)Yemen (2006)
Lower-middle incomeArmenia (2001)Cameroon (2002)China-Shandong Province (2004)China-Shanghai (2006)El-Salvador (2006)Fiji (2004)Indonesia (2004)Jordan (2004)Morocco (2004)Peru (2005) Philippines (2005)Sri Lanka (2001)Syria (2003)Tunisia (2004)
Upper-middle incomeBrazil-Rio de Janeiro (2001)Kazakhstan (2004)Lebanon (2004)Malaysia (2004)South Africa - Kwazulu Natal (2001)
High IncomeKuwait (2004)United Arab Emirates (2006)
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Results: Availability (%)
LPG OB LPG OB LPG OB LPG OBSalb Salb Salb Salb Becl Becl Becl Becl
LI (26) 62.5% 19.5% 84.8% 45.0% 35.0% 17.3%LMI (16) 71.6% 23.1% 60.4% 68.5% 27.8% 43.3% 40.4% 28.8%UMI (5) 96.9% 82.2% 25.0% 80.0%HI (2) 43.5% 98.0% 78.0%Overall Med Avail. N = 47) 62.5% 21.6% 82.5% 58.5% 27.8% 43.3% 35.0% 28.8%
public sector patient availability
private pharmacies patient availability
public sector patient availability
private pharmacies patient availability
Overall Availability of Beclomethasone and Salbutamol– WB Income Group Classifications
Note: The numbers next to the income categories represent the number of countries that were found in the WHO HAI website
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Procurement and Patient PricesAdjusted for CPI and MSH prices
WHO Region Becl Salb Becl Salb Becl Salb Becl SalbAFRO (12) 2.01 2.72 4.14 3.58 13.17EMRO (12) 1.25 1.21 4.05 1.51 1.46 2.67EURO (5) 3.03 3.13 3.94 3.68 3.51 4.27PAHO (3) 6.19 4.97 4.32 3.53SEARO (9) 4.19 3.16WPRO (7) 4.53 2.67 4.95 7.10 4.58 6.15 9.45Overall Median Med. MPR N = 48 1.90 2.20 4.83 3.68 1.46 3.12 6.15 9.45
public sector procurement prices public sector patient prices
Median Price Ratios of Beclomethasone and Salbutamol with surveys divided into the World Health Organization Regions
LPG OBLPG OB
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Median Price Ratios of Beclomethasone and Salbutamol with surveys divided into Income Group categoriesAdjusted for CPI, MSH prices and PPP
LPG OB LPG OB LPG OB LPG OB
Income groupLI (25) 3.09 13.17 4.48 6.72 4.90 5.50LMI (15) 5.24 9.45 4.28 9.41 1.46 6.15 4.51 7.78UMI (5) 4.27 3.40 6.21 3.43 9.85HI (2) 1.67 4.38 2.76Overall Median Med. MPR N = 47 3.51 9.31 4.41 7.28 1.46 6.15 4.90 7.29
Salbutamol Beclomethasone
Public sector patient prices
Private pharmacies patient prices
Public sector patient prices
Private pharmacies
patient prices
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AffordabilityDays wages of Lowest Paid Government Worker
Note: Average income often below lowest government wage Need for multiple medicines
Who Region OB LPG OB LPGAFRO (15) 4.18 2.44 8.89EMRO (14) 1.28 0.75 1.87 0.99EURO (5) 2.98 2.79PAHO (3) 1.95SEARO (8) 0.62 0.58 1.10WPRO (7) 1.41 0.74 3.23
All Regions combined N = 52 1.67 0.91 3.23 1.13
Salbutamol Beclomethasone
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Discussion & Policy options Availability
Ensure availability of BOTH Beclo and salbutamol Increase public sector funding for Asthma medicines
Procurement Some countries: can improve on procurement prices possibly
through ADF Where procurement prices are good consider selling at cost to
private sector or through patient associations Patient prices
Lower taxes & tariffs Promote the use of generics Reduce mark-ups