PP63 Factors Influencing Drug Prices Among Philippine Public Hospitals

2018 ◽  
Vol 34 (S1) ◽  
pp. 91-91
Author(s):  
John Wong ◽  
Cheyenne Ariana Erika Modina ◽  
Geminn Louis Apostol ◽  
Joy Bagas
Keyword(s):  
Performance Monitoring ◽  
Economies Of Scale ◽  
The Philippines ◽  
Public Hospitals ◽  
Essential Medicines ◽  
World Health ◽  
Price Ratio ◽  
Pharmaceutical Management ◽  
Hospital Units ◽  
Procurement Planning

Introduction:In the Philippines, medicines are procured at higher rates in government hospitals. The prices of essential medicines have high variability, and a significant portion of out-of-pocket expenditures by Filipinos is for medicines. This study's objective is to determine the factors associated with the variation in drug pricing among public hospitals.Methods:This was a mixed-methods, case-control study of 57 hospitals. Two tools were developed based on: (i) Management Sciences for Health (MSH)’s Rapid Pharmaceutical Management Assessment and (ii) World Health Organization (WHO)’s Good Pharmaceutical Practices. The dependent variable is a drug price reference ratio of a preselected drug basket. Examples of factors studied are: (i) preference for generics, (ii) procurement type, and (iii) time out of stock.Results:Hospitals with proper procurement planning and performance monitoring are expected to decrease the price ratio (R = -0.030). However, interview data showed that forecasting is still not robust enough. Past consumption (91 percent) remained the most frequently used input to procurement planning. Few hospitals took into consideration other factors such as morbidity, mortality, and patient demographics. The expertise of hospital procurement staff increases the hospital's price mark-up. Interview results suggest this is because members and hospital units do not meet eye-to-eye to ensure accountability and coordination across units in planning and implementing the procurement procedures.Conclusions:By having a forward-looking procurement plan, forecasting can be more efficient. Potential improvement lies in finding mechanisms where nearby hospitals could participate in pooled procurement. Pooled procurement could have an impact on reducing prices by capturing economies of scale, provided this is operated efficiently and transparently.

scholarly journals What Factors Hindered the Access to Essential Anticancer Medicine in Public Hospitals for the Local Population in Hubei Province, China

2021 ◽  
Vol 12 ◽  
Author(s):  
Chaoyi Chen ◽  
Zhanchun Feng ◽  
Yufeng Ding ◽  
Ziqi Yan ◽  
Jia Wang ◽  
...  
Keyword(s):  
Local Population ◽  
Hubei Province ◽  
Public Hospitals ◽  
Essential Medicines ◽  
World Health ◽  
High Price ◽  
Tertiary Hospitals ◽  
Originator Brand ◽  
Health Action ◽  
Health Organization

Background:Cancer poses a serious threat to one’s health, which caused significant economic burden on the family and society. Poor availability and affordability resulted in some essential medicines failing to meet the basic health needs of this group of patients. The objective of this study was to evaluate the availability, prices and affordability of 32 anticancer essential medicines in Hubei Province, China.Methods: Data on the availability and price related information of 32 essential anticancer medicines in the capital and five other cities of Hubei Province were collected. A total of 28 hospitals were sampled, which included 13 tertiary hospitals and 15 secondary hospitals. We used the standard methods developed by the World Health Organization and Health Action International to compare the differences in drug price, availability and affordability between secondary hospitals and tertiary hospitals.Results: Overall, the availability of medicine was higher in tertiary hospitals. The average availability of originator brand (OBs) was 13.70% (tertiary hospitals) VS 6.67% (secondary hospitals), and lowest-priced generic (LPGs) was 62.83% (tertiary hospitals) VS 42.92% (secondary hospitals). The MPR value of most sampled medicines in secondary hospitals were less than 1. In contrast, the MPR of Cytarabine (17.15), Oxaliplatin (12.73) were significantly higher than the international reference price. The top three OBs’ total expenses for 30-days treatment were Irinotecan, Oxaliplatin, Bicalutamide. Further, their affordability was relative low, as the costs for one course using these medicines were much higher than 20% of the minimum family monthly income.Conclusion: Though the “Zero Mark-Up” and “Centralized procurement policy of anti-tumor drugs” policies have been implemented in China, the availability issue yet to be addressed. High price and low affordability were the major barriers to the access of essential anticancer medicines. Measures should be taken to provide sufficient, available and affordable medicines to patients in need.

scholarly journals Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Caijun Yang ◽  
Shuchen Hu ◽  
Dan Ye ◽  
Minghuan Jiang ◽  
Zaheer-Ud-Din Babar ◽  
...  
Keyword(s):  
Private Sector ◽  
Access To Medicines ◽  
Public Hospitals ◽  
Essential Medicines ◽  
Shaanxi Province ◽  
Price Ratio ◽  
Medicine Price ◽  
Cross Sectional ◽  
The Public ◽  
Health Action

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 (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). 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.

scholarly journals Prices, Availability And Affordability Of Essential Medicines For Non-Communicable Diseases: A Facility Based Survey In District Abbotabad

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Khizran Mir ◽  
Hafsa Ayyub
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Public Procurement ◽  
Essential Medicine ◽  
Simple Random Sampling ◽  
Communicable Diseases ◽  
Essential Medicines ◽  
World Health ◽  
Price Ratio ◽  
Non Communicable Diseases

Background: Non communicable diseases (NCDs) are spreading like an epidemic worldwide. Essential medicines are crucial for prevention and control of NCDs. World Health Organization (WHO) has set a benchmark of 80% availability of essential medicines in public and private facilities. Availability being a predictor of access to medicines is low in Low and Middle income countries (LMICs). The objective of this study is to determine price, availability and affordability of essential medicines for NCDs in District Abbottabad. Methods: This study was based on the standardized protocol provided by WHO and Health Action International (HAI) for determination of availability, prices and affordability of medicines. A total of 50 medicines for NCDs that were enlisted in Essential Medicine List of district Khyber Pakhtun Khawa were selected for the study. Twenty seven medicine dispensing facilities belonging to public, private and other basic health units (BHUs) (managed by PPHI) sectors were surveyed in the district. Simple random sampling was employed to select facilities. Results: The mean overall percentage availability of essential medicines for NCDs was 0.1% for original brand and 1.9% for low price generic in public sector. Overall availability was better in private and other sectors (32.9% for OB and 13.8% for LPGs and 5.3% for OB and 11.1% for LPG respectively). The prices in public procurement sector were competitive. The median price ratio (MPR) in public procurement sector was 0.56. Prices were higher comparatively in private sector with MPR 2.83. Most of the medicines require less than a day wage to buy 30 days treatment. Conclusions: The availability of essential medicines for NCDs was poor in District Abbottabad. None of the sectors reached the benchmark of 80% with regard to availability of medicines. LPGs were not frequently available in the private sector. However, prices were reasonable in public sector and acceptable in private sector. Medicines were found to be affordable but affordability may differ for people living below poverty line of US $1.

scholarly journals Trends in Sales Volumes of Cancer Medicines in Six Asian Countries Working Toward Universal Health Coverage

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 220s-220s
Author(s):  
A. Ferrario ◽  
P. Stephens ◽  
D. Ross-Degnan ◽  
A. Wagner
Keyword(s):  
Universal Health Coverage ◽  
The Philippines ◽  
Essential Medicines ◽  
World Health ◽  
Medical Documentation ◽  
Percentage Increase ◽  
Health Coverage ◽  
Asian Countries ◽  
Middle Income ◽  
Universal Health

Background: In low- and middle-income (LMIC), medicines represent an important proportion of total out-of-pocket expenditures on health care and should therefore be a key target for financial protection through inclusion in benefit packages under universal health coverage (UHC). For antineoplastic medicines, this need will become even more urgent with the increasing incidence of cancers in LMIC and the availability of new, highly priced cancer. Previous studies have shown that countries have listed cancer medicines recommended in the World Health Organization (WHO) essential medicines list (EML) in their national EMLs. However, little is known about use of these medicines at country level and changes in use over time as countries work toward UHC. Aim: To analyze trends in sales volumes of cancer medicines in China, Indonesia, Kazakhstan, Malaysia, the Philippines and Thailand between 2006 and 2017. Methods: Using quarterly data from IQVIA (former IMS and Quintiles) on sales volumes in 6 middle-income Asian countries of cancer medicines (ATC-L01/02) included in the 2017 WHO EML, we estimated annual sales by international nonproprietary name, year and country. Sales volumes were estimated in total milligrams and total defined daily doses (DDD) per new cancer case. The reference DDD were taken from the German Institute of Medical Documentation and Information. We adjusted total mg and DDD by the total number of new cancer cases per country in 2012 ( Globocan 2012 ). Results: The 2017 WHO EML contains 49 medicines in the antineoplastic section; 40 of them were used in 1 or more countries included in the study. Availability of these 40 medicines ranged from 33 in Indonesia to 40 in the Philippines. The median percentage increase in sales volumes between 2006 and 2017 ranged from 42% in Thailand to 94% in Indonesia. Use of new, high-priced medicines such as trastuzumab and rituximab increased more than 90% and 72% in all countries, respectively, during the study period. Limitations: National sales volumes are extrapolated from standardized audits of procurement and sales data in sample facilities and/or distribution data supplied by wholesalers in each country and may underestimate actual sales. Given different indications for which a cancer medicine can be used and highly individualized antineoplastic treatment regimens and dosages, standardized DDD do not represent actual prescribed daily doses. Growth rates will reflect the place of the medicine within the national treatment guidelines and healthcare delivery capacity. Conclusion: This study provides evidence that use of WHO-recommended essential medicines for cancers increased in 6 Asian countries working toward UHC. Many factors are likely to have contributed to this outcome, including improvements in diagnosis and treatments. The next step in this study will be to assess the role of insurance coverage changes as a factor contributing to changes in utilization of cancer medicines.

scholarly journals Availability, prices and affordability of essential medicines: A cross-sectional survey in Hanam province, Vietnam

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260142
Author(s):  
Huong Thi Thanh Nguyen ◽  
Dai Xuan Dinh ◽  
Trung Duc Nguyen ◽  
Van Minh Nguyen
Keyword(s):  
Public Sector ◽  
Urban Areas ◽  
Health Facilities ◽  
Essential Medicines ◽  
World Health ◽  
Price Ratio ◽  
The Public ◽  
Private Medicine ◽  
The Mean ◽  
Medicine Outlets

Objective To measure medicines’ prices, availability, and affordability in Hanam, Vietnam. Methods The standardized methodology developed by the World Health Organization (WHO) and Health Action International was used to survey 30 essential medicines (EMs) in 30 public health facilities and 35 private medicine outlets in 2020. The availability of medicine was computed as the percentage of health facilities in which this medicine was found on the data-collection day. International reference prices (IRPs) from Management Sciences for Health (2015) were used to compute Median Price Ratio (MPR). The affordability of treatments for common diseases was computed as the number of days’ wages of the lowest-paid unskilled government worker needed to purchase medicines prescribed at a standard dose. Statistic analysis was done using R software version 4.1.1. Results The mean availability of originator brands (OBs) and lowest-priced generics (LPGs) was 0.7%, 63.2% in the public sector, and 13.7%, 47.9% in the private sector, respectively. In private medicine outlets, the mean availability of both OBs and LPGs in urban areas was significantly higher than that in rural areas (p = 0.0013 and 0.0306, respectively). In the public sector, LPGs’ prices were nearly equal to their IRPs (median MPRs = 0.95). In the private medicine outlets, OBs were generally sold at 6.24 times their IRPs while this figure for LPGs was 1.65. The affordability of LPGs in both sectors was good for all conditions, with standard treatments costing a day’s wage or less. Conclusion In both sectors, generic medicines were the predominant product type available. The availability of EMs was fairly high but still lower than WHO’s benchmark. A national-scale study should be conducted to provide a comprehensive picture of the availability, prices, and affordability of EMs, thereby helping the government to identify the urgent priorities and improving access to EMs in Vietnam.

scholarly journals What Factors Hindered the Access to Essential Anti-Cancer Medicine in Public Hospitals amongst the Local Population in Hubei Province, China?

2021 ◽  
Author(s):  
Chaoyi Chen ◽  
Zhanchun Feng ◽  
Ziqi Yan ◽  
Yufeng Ding ◽  
Jia Wang ◽  
...  
Keyword(s):  
Day Treatment ◽  
Local Population ◽  
Hubei Province ◽  
Public Hospitals ◽  
Essential Medicines ◽  
World Health ◽  
High Price ◽  
Tertiary Hospitals ◽  
Originator Brand ◽  
Health Organization

Abstract BackgroundCancer poses a serious threat to one’s health, which caused significant economic burden on the family and society. Poor availability and affordability resulted in some essential medicines failing to meet the basic health needs of this group of patients. The objective of this study was to evaluate the availability, prices and affordability of 32 anticancer essential medicines in Hubei Province, China.MethodsData on the availability and price related information of 32 essential anticancer medicines in the capital and five other cities of Hubei Province were collected. A total of 28 hospitals were sampled, which included 13 tertiary hospitals and 15 secondary hospitals. We used the standard methods developed by the World Health Organization (WHO) and Health Action International (HAI) to compare the differences in drug price, availability and affordability between secondary hospitals and tertiary hospitals. ResultsOverall, the availability of medicine was higher in tertiary hospitals. The average availability of originator brand (OBs) was 13.70% (tertiary hospitals) VS 6.67% (secondary hospitals), and lowest-priced generic (LPGs) was 62.83% (tertiary hospitals) VS 42.92% (secondary hospitals). The MPR value of most sampled medicines in secondary hospitals were less than 1. In contrast, the MPR of Cytarabine (17.15), Oxaliplatin (12.73) were significantly higher than the international reference price. The top three OBs’ total expenses for 30-day treatment were Irinotecan, Oxaliplatin, Bicalutamide. Further, their affordability was relative low, as the costs for one course using these medicines were much higher than 20% of the minimum family monthly income.ConclusionThough the “Zero Mark-Up” and “Two Vote” Policies have been implemented in China, the availability issue yet to be addressed. High price and low affordability were the major barriers to the access of essential anticancer medicines. Measures should be taken to provide sufficient, available and affordable medicines to patients in need.

scholarly journals Evaluation of availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255567
Author(s):  
Nkeiruka Grace Osuafor ◽  
Chinwe Victoria Ukwe ◽  
Mathew Okonta
Keyword(s):  
Private Hospital ◽  
Public Hospitals ◽  
World Health ◽  
Price Ratio ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Private Hospitals ◽  
Hospital Pharmacies ◽  
Health Organization ◽  
Government Worker

Objective To assess the availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria. Methods A cross-sectional survey involving 27 private pharmacies, 13 public pharmacies, and 25 private hospital pharmacies in Abuja was conducted using the standardized World Health Organization/Health Action International methodology. The availability percentage for each pharmacy sector and each medicine was analyzed. The median price ratio (MPR) (ratio of the median price to the international reference prices) of the medicines were evaluated accordingly. Affordability was assessed by calculating the number of days’ wages the lowest-paid unskilled government worker required to purchase a month worth of the standard treatment for a chronic condition. Results The availability of cardiovascular (CV) medicines ranged from 28.4% (in private hospital pharmacies) to 59.9% (in private pharmacies). There was mixed variability in the mean availability of Originator Brands (OBs) and Lowest Priced Generics (LPGs) anti-diabetic drugs with the highest availability being OBs 36% and LPGs 40.2%, in private pharmacies and public pharmacies, respectively. The availability of global drugs ranged from 49.7% in private hospitals to 68.8% in private pharmacies. Two cardiovascular and four global medicines had greater than 80% availability across the pharmaceutical sectors. The median price ratio for OBs and LPGs was 9.60 and 1.72 for procurement, it was 8.08 and 2.60 in private pharmacies, 13.56 and 2.66 in public hospitals, and 16.38 and 7.89 in private hospitals. The percentage markup on LPG was 49.4% in public hospitals, 51.4% in private pharmacies, and 323% in private hospitals. Only nine medicines in both public hospitals and private pharmacies and two in the private hospital pharmacies required less than the daily wage of the lowest-paid government worker. Conclusion The availability of cardiovascular, diabetes, and global medicines was below 80% across the different pharmaceutical sectors in Abuja and the medicines were unaffordable. Although the prices were generally exorbitant, private pharmacies offered the best options in terms of availability, pricing, and affordability of medicines. Therefore, the results of this study emphasize the pertinence of enforcing policies that facilitate the availability, pricing, and affordability of cardiovascular, diabetes, and global medicines.

scholarly journals Availability, prices and affordability of essential medicines in Zhejiang Province, China

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241761
Author(s):  
Zuojun Dong ◽  
Qiucheng Tao ◽  
Bobo Yan ◽  
Guojun Sun
Keyword(s):  
Public Sector ◽  
Zhejiang Province ◽  
Essential Medicines ◽  
World Health ◽  
Price Ratio ◽  
Public And Private ◽  
The Public ◽  
The Mean ◽  
Daily Wage ◽  
Health Organization

Objective To evaluate the availability, prices, and affordability of essential medicines in Zhejiang Province, China. Methods The survey was carried out in Zhejiang Province in 2018 following the methodology of the World Health Organization (WHO) and Health Action International (HAI). This method is an international standard method.Data on 50 medicines were collected from public health facilities and private pharmacies. Medication prices were compared with international reference prices to obtain a median price ratio. The affordability of medicines was measured based on the daily wage of the lowest-paid unskilled government worker. In private pharmacies, the mean availability of Originator Brands (OBs) and Lowest-priced Generics (LPGs) was 36.7% and 40.3%, respectively. Findings The effects of the mean availability of OBs and LPGs were seen in private pharmacies. Correspondingly, the average availability of OBs and LPGs was 41.8% and 35.1% in the public sector, respectively. In the public sector, the median price ratios (MPRs) were 5.21 for generics and 13.49 for OBs. In the private sector, the MPRs were 4.94 for generics and 14.75 for OBs. Treating common diseases with LPGs was generally affordable, while treatment with OBs was less affordable. Conclusions In Zhejiang Province, low availability was observed for medicines surveyed in the public and private sectors. Price differences between originator brands and generics in both sectors are apparent. OBs were more expensive than LPGs in both the public and private sectors. Low availability affects access to essential medicines. Policy measures should be taken to improve the availability of essential medicines.

scholarly journals Evaluating essential medicines for treating childhood cancers: availability, price and affordability study in Ghana

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kofi Boamah Mensah ◽  
Adwoa Bemah Boamah Mensah ◽  
Varsha Bangalee ◽  
Neelaveni Padayachee ◽  
Frasia Oosthuizen
Keyword(s):  
Low Income ◽  
Tertiary Hospital ◽  
Essential Medicines ◽  
World Health ◽  
Unskilled Worker ◽  
Price Ratio ◽  
Childhood Cancers ◽  
The Mean ◽  
The Government ◽  
Health Organization

Abstract Introduction Access to childhood cancer medicines is a critical global health challenge. There is a lack of sufficient context-specific data in Ghana on access to essential medicines for treating childhood cancers. Here, we present an analysis of essential cancer medicine availability, pricing, and affordability using the pediatric oncology unit of a tertiary hospital as the reference point. Method Data on prices and availability of 20 strength-specific essential cancer medicines and eight non-cancer medicines were evaluated using the modified World Health Organization (WHO)/Health Action International method. Two pharmacies in the hospital and four private pharmacies around the hospital were surveyed. We assessed their median price ratio using the WHO international reference price guide. The number of days wages per the government daily wage salary was used to calculate the affordability of medicines. Results The mean availability of essential cancer medicines and non-cancer medicines at the hospital pharmacies were 27 and 38% respectively, and 75 and 84% respectively for private pharmacies. The median price ratio of cancer medicines was 1.85, and non-cancer medicines was 3.75. The estimated cost of medicines for treating a 30 kg child with Acute lymphoblastic leukaemia was GHȻ 4928.04 (US$907.56) and GHȻ 4878.00 (US$902.62) for Retinoblastoma, requiring 417 and 413-days wages respectively for the lowest-paid unskilled worker in Ghana. Conclusion The mean availability of cancer medicines at the public and private pharmacies were less than the WHO target of 80%. The median price ratio for cancer and non-cancer medicines was less than 4, yet the cost of medicines appears unaffordable in the local setting. A review of policies and the establishment of price control could improve availability and reduce medicines prices for the low-income population.

Chemistry of Iodinated Contrast Media (ICM): A Minireview

2020 ◽  
Vol 17 ◽  
Author(s):  
Maithili Pramod Joshi ◽  
Ameya Chaudhari ◽  
Prashant S. Kharkar ◽  
Shreerang V. Joshi
Keyword(s):  
Adverse Effects ◽  
Contrast Media ◽  
Aqueous Solubility ◽  
Synthetic Methods ◽  
Essential Medicines ◽  
World Health ◽  
Iodinated Contrast Media ◽  
Environmental Aspects ◽  
Iodinated Contrast ◽  
Health Organization

: Historically, the use of Iodinated Contrast Media (ICM) for diagnostic purposes, particularly radiography and computed tomography (CT), is well-known. Many of the ICM are included in the World Health Organization (WHO)’s List of Essential Medicines. Depending on the chemotype and the presence of ionizable functional group(s), the ICM are categorized in the ionic/nonionic monomers/dimers. The lipophilicity, aqueous solubility, viscosity and osmolality are major characteristics dictating their use for one procedure versus the other. Over last several decades, substantial advancement occurred in the design and development of novel ICM, solely to reduce their propensity to cause adverse effects. Given the nature of their acute usage, some of the agents with appreciable toxicity are still used. Understanding their chemistry aspects is crucial to appreciate, acknowledge and justify the usage of these extremely important torch-bearers of diagnostic agent’s class. The present review article presents an in-depth overview of the synthetic methods, therapeutic indications, potential adverse effects along with the commercial and environmental aspects of ICM. The safety and tolerability of these agents is a field that has gained significant importance, which is given due importance in the discussion.

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