The Availability, Pricing and Affordability of Essential Diabetes Medicines in 17 Low-, Middle- and High-Income Countries

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Abstract

Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries.Methods: Data on affordability, availability and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organisation/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of Innovator Brand (IB) and Lowest Priced Generic (LPG) of diabetes medicines by WHO regional groupings and by country level.Results: Lowest priced generic of Metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs & LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure one-month’s supply of IB of Insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p=0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of Insulin 100IU/ml and metformin 500mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively.Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.
Original languageEnglish
Article number1375
Number of pages10
JournalFrontiers in Pharmacology
Volume10
DOIs
Publication statusPublished - 19 Nov 2019

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Costs and Cost Analysis
Insulin
Penicillin G Benzathine
Bangladesh
Tanzania
Pharmacies
Metformin
Primary Health Care
Armenia
Qatar
United Arab Emirates
Oman
Afghanistan
Sri Lanka
Jordan
Nepal
Saudi Arabia
Egypt
Salaries and Fringe Benefits
Russia

Cite this

@article{7b22465119a5450abe0a30e794d5adb8,
title = "The Availability, Pricing and Affordability of Essential Diabetes Medicines in 17 Low-, Middle- and High-Income Countries",
abstract = "Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries.Methods: Data on affordability, availability and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organisation/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of Innovator Brand (IB) and Lowest Priced Generic (LPG) of diabetes medicines by WHO regional groupings and by country level.Results: Lowest priced generic of Metformin 500 mg had the highest total mean availability (≥80{\%}) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21{\%} (IBs & LPGs), where IB was more frequently available than LPG (50{\%} vs. 26{\%}) across 17 surveyed countries. Patients would have to spend more to procure one-month’s supply of IB of Insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p=0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of Insulin 100IU/ml and metformin 500mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively.Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.",
keywords = "Affordability, Availability, Diabetes, Essential medicines, Primary care pharmacy",
author = "Zaheer-Ud-Din Babar and Sara Ramzan and Faris El-Dahiyat and Ilias Tachmazidis and Adeola Adebisi and Hasan, {Syed Shahzad}",
year = "2019",
month = "11",
day = "19",
doi = "10.3389/fphar.2019.01375",
language = "English",
volume = "10",
journal = "Frontiers in Pharmacology",
issn = "1663-9812",
publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - The Availability, Pricing and Affordability of Essential Diabetes Medicines in 17 Low-, Middle- and High-Income Countries

AU - Babar, Zaheer-Ud-Din

AU - Ramzan, Sara

AU - El-Dahiyat, Faris

AU - Tachmazidis, Ilias

AU - Adebisi, Adeola

AU - Hasan, Syed Shahzad

PY - 2019/11/19

Y1 - 2019/11/19

N2 - Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries.Methods: Data on affordability, availability and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organisation/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of Innovator Brand (IB) and Lowest Priced Generic (LPG) of diabetes medicines by WHO regional groupings and by country level.Results: Lowest priced generic of Metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs & LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure one-month’s supply of IB of Insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p=0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of Insulin 100IU/ml and metformin 500mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively.Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.

AB - Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries.Methods: Data on affordability, availability and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organisation/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of Innovator Brand (IB) and Lowest Priced Generic (LPG) of diabetes medicines by WHO regional groupings and by country level.Results: Lowest priced generic of Metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs & LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure one-month’s supply of IB of Insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p=0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of Insulin 100IU/ml and metformin 500mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively.Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.

KW - Affordability

KW - Availability

KW - Diabetes

KW - Essential medicines

KW - Primary care pharmacy

U2 - 10.3389/fphar.2019.01375

DO - 10.3389/fphar.2019.01375

M3 - Article

VL - 10

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

SN - 1663-9812

M1 - 1375

ER -