scholarly journals Price, availability and affordability of medicines

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Brenda S. Mhlanga ◽  
Fatima Suleman
Keyword(s):  
Supply Chain ◽  
Public Sector ◽  
Low Income ◽  
Essential Medicines ◽  
World Health ◽  
Middle Income ◽  
Originator Brand ◽  
Private And Public ◽  
Daily Wage ◽  
Health Organization

Background: Medicines play an important role in healthcare, but prices can be a barrier to patient care. Few studies have looked at the prices of essential medicines in low- and middle-income countries in terms of patient affordability.Aim: To determine the prices, availability and affordability of medicines along the supply chain in Swaziland.Setting: Private- and public-sector facilities in Manzini, Swaziland.Methods: The standardised methodology designed by the World Health Organization and Health Action International was used to survey 16 chronic disease medicines. Data were collected in one administrative area in 10 private retail pharmacies and 10 public health facilities. Originator brand (OB) and lowest-priced generic equivalent (LPG) medicines were monitored and these prices were then compared with international reference prices (IRPs). Affordability was calculated in terms of the daily wage of the lowest-paid unskilled government worker.Results: Mean availability was 68% in the public sector. Private sector OB medicines were priced 32.4 times higher than IRPs, whilst LPGs were 7.32 times higher. OBs cost473% more than LPGs. The total cumulative mark-ups for individual medicines range from 190.99% – 440.27%. The largest contributor to add-on cost was the retail mark-up (31% – 53%). Standard treatment with originator brands cost more than a day’s wage.Conclusion: Various policy measures such as introducing price capping at all levels of the medicine supply chain, may increase the availability, whilst at the same time reducing the prices of essential medicines for the low income population.

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 Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

2020 ◽  
Author(s):  
Faith A. Okalebo ◽  
Eric M. Guantai ◽  
Aggrey O. Nyabuti
Keyword(s):  
Drug Use ◽  
Low Income ◽  
Primary Healthcare ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Rational Use ◽  
Health Organization ◽  
Consultation Time ◽  
Primary Healthcare Centers

ABSTRACTBackgroundIrrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study set out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/ International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.MethodsTen PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three-hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.ResultsThe average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6– 1.8), percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%) and percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.ConclusionThe survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

scholarly journals High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0241899
Author(s):  
Barbara Bortone ◽  
Charlotte Jackson ◽  
Yingfen Hsia ◽  
Julia Bielicki ◽  
Nicola Magrini ◽  
...  
Keyword(s):  
The United States ◽  
Antibiotic Consumption ◽  
Essential Medicines ◽  
World Health ◽  
Fixed Dose ◽  
Middle Income ◽  
Us Fda ◽  
Analysis System ◽  
Health Organization ◽  
Data Analysis System

Antibiotic fixed dose combinations (FDCs) can have clinical advantages such as improving effectiveness and adherence to therapy. However, high use of potentially inappropriate FDCs has been reported, with implications for antimicrobial resistance (AMR) and toxicity. We used a pharmaceutical database, IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS®), to estimate sales of antibiotic FDCs from 75 countries in 2015. Antibiotic consumption was estimated using standard units (SU), defined by IQVIA as a single tablet, capsule, ampoule, vial or 5ml oral suspension. For each FDC antibiotic, the approval status was assessed by either registration with the United States Food and Drug Administration (US FDA) or inclusion on the World Health Organization (WHO) Essential Medicines List (EML). A total of 119 antibiotic FDCs were identified, contributing 16.7 x 109 SU, equalling 22% of total antibiotic consumption in 2015. The most sold antibiotic FDCs were amoxicillin-clavulanic acid followed by trimethoprim/sulfamethoxazole and ampicillin/cloxacillin. The category with the highest consumption volume was aminopenicillin/β-lactamase inhibitor +/- other agents. The majority of antibiotic FDCs (92%; 110/119) were not approved by the US FDA. Of these, the most sold were ampicillin/cloxacillin, cefixime/ofloxacin and metronidazole/spiramycin. More than 80% (98/119) of FDC antibiotics were not compatible with the 2017 WHO EML. The countries with the highest numbers of FDC antibiotics were India (80/119), China (25/119) and Vietnam (19/119). There is high consumption of FDC antibiotics globally, particularly in middle-income countries. The majority of FDC antibiotic were not approved by either US FDA or WHO EML. International initiatives such as clear guidance from the WHO EML on which FDCs are not appropriate may help to regulate the manufacturing and sales of these antibiotics.

scholarly journals The burden of serious health-related suffering among cancer decedents: Global projections study to 2060

2020 ◽  
pp. 026921632095756
Author(s):  
Katherine E Sleeman ◽  
Barbara Gomes ◽  
Maja de Brito ◽  
Omar Shamieh ◽  
Richard Harding
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Population Based ◽  
World Health ◽  
Low Income Countries ◽  
Cancer Type ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related ◽  
Health Organization

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

scholarly journals Immunological Assays used to Support Efficacy of Zika Virus Vaccines

2019 ◽  
Vol 4 (3) ◽  
pp. 97
Author(s):  
Kenneth H. Eckels ◽  
Rafael A. De La Barrera ◽  
Joseph Robert Putnak
Keyword(s):  
Public Health ◽  
Public Sector ◽  
Zika Virus ◽  
Public Health Emergency ◽  
World Health ◽  
Vaccine Candidates ◽  
The World ◽  
Private And Public ◽  
Immunological Assays ◽  
Health Organization

In February of 2016, the World Health Organization (WHO) declared Zika virus (ZIKV) a Public Health Emergency of International Concern. This prompted a rapid response from both the private and public sector resulting in the generation of several promising vaccine candidates. In this review, we discuss published scientific efforts associated with these novel vaccines, emphasizing the immunological assays used to evaluate their immunogenicity and efficacy, and support future licensure.

scholarly journals Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen

2020 ◽  
Vol 18 (1) ◽  
pp. 175
Author(s):  
Mohamed Izham Mohamed Ibrahim ◽  
Mohammed Alshakka ◽  
Nazeh Al-abd ◽  
Awsan Bahattab ◽  
Wafa Badulla
Keyword(s):  
Essential Medicines ◽  
World Health ◽  
Private Hospitals ◽  
Public And Private ◽  
Middle Income ◽  
Short Supply ◽  
Healthcare Facilities ◽  
Private Healthcare ◽  
Healthcare Settings ◽  
Health Organization

Background: Medicine and medical supplies are often in short supply in countries suffering from the scourge of conflict. Effective medicine supply policies are lacking in many low- and middle-income countries (LMICs), particularly during conflict. This study aimed to assess the availability of essential medicines in both the public and private healthcare sectors. Methods: The study was conducted by administering a survey from November 2017 to February 2018 using the World Health Organization/Health Action International (WHO/HAI) guidelines and methodology. Thirty healthcare facilities in thirteen districts from three governorates in Yemen were included in the assessment of thirty essential medicines. The results were reported as frequencies and percentages of outlets with available medicines on the day of data collection. Results: A set of 30 vital and essential medicines were selected from the list of essential medicines that are used in healthcare centers in Yemen to treat prevalent diseases. In general, only 52.8% of the selected medicines were available in public and private healthcare settings. The distribution and availability of medicines in the three governorates were approximately equal. The availability of medicines was better in the private healthcare settings, specifically 73.3% in private hospitals and approximately 79.7% in private pharmacies. Conclusions: The availability of essential medicines during this state of conflict in three governorates in Yemen is low, in both public and private hospitals and healthcare centers. Many of the medications that were not available are used to treat chronic illnesses.

Safe Reopening Following Generalized Lockdowns: A Strategy Based on Evidence from 24 Worldwide Countries

2021 ◽  
Author(s):  
Abu S. Shonchoy ◽  
Khandker S. Ishtiaq ◽  
Sajedul Talukder ◽  
Nasar U. Ahmed ◽  
Rajiv Chowdhury
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Simulation Analysis ◽  
Epidemiological Data ◽  
World Health ◽  
Optimal Timing ◽  
Middle Income ◽  
Capacity Limits ◽  
Positive Rate ◽  
Health Organization

Abstract While the effectiveness of lockdowns to reduce Coronavirus Disease-2019 (COVID-19) transmission is well established, uncertainties remain on the lifting principles of these restrictive interventions. World Health Organization recommends case positive rate of 5% or lower as a threshold for safe reopening. However, inadequate testing capacity limits the applicability of this recommendation, especially in the low-income and middle-income countries (LMICs). To develop a practical reopening strategy for LMICs, in this study, we first identify the optimal timing of safe reopening by exploring accessible epidemiological data of 24 countries during the initial COVID-19 surge. We find that safely reopening requires a two-week waiting period, after the crossover of daily infection and recovery rates – coupled with a post-crossover continuous negative trend in daily new cases. Epidemiologic SIRM model-based simulation analysis validates our findings. Finally, we develop an easily interpretable large-scale reopening (LSR) index, which is an evidence-based toolkit – to guide/inform the reopening decisions for LMICs.

scholarly journals Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 489 ◽  
Author(s):  
Ioannis Hodges-Mameletzis ◽  
Shona Dalal ◽  
Busisiwe Msimanga-Radebe ◽  
Michelle Rodolph ◽  
Rachel Baggaley
Keyword(s):  
Sub Saharan Africa ◽  
Essential Medicines ◽  
World Health ◽  
Middle Income ◽  
Income Status ◽  
The World ◽  
Sub Saharan ◽  
Health Organization ◽  
Exposure Prophylaxis ◽  
Oral Prep

In September 2015, the World Health Organization (WHO) launched evidence-based guidelines by recommending that any person at substantial HIV risk should be offered oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) as an additional prevention choice. Since 2017, PrEP medicines have also been listed in the WHO’s Essential Medicines List, including TDF/emtricitabine (FTC) and TDF in combination with lamivudine (3TC). A descriptive policy review and analysis of countries adopting WHO’s 2015 recommendation on oral PrEP was conducted. As of June 2018, we identified 35 countries that had some type of policy on oral PrEP, and an additional five countries where a specific policy on PrEP is currently pending. A total of 19 high-income countries (HICs) and 21 low- and middle-income countries (LMICs) have adopted or have a pending policy. Most countries that have adopted or pending PrEP are in the European (42.9%) or African (30.0%) region. TDF/FTC is the most commonly recommended PrEP drug in the guidelines reviewed, although seven countries, namely in sub-Saharan Africa (6/7), are also recommending the use of TDF/3TC for PrEP. In sum, by the end of 2018, at least 40 countries (20.6%) are anticipated to have adopted WHO’s oral PrEP recommendation. Nonetheless, policy uptake does not reflect broader programmatic coverage of PrEP services, which remain limited across all settings, irrespective of income status. Enhancing global partnerships is needed to support and track ongoing policy adoption and to ensure that policy is translated into meaningful implementation of PrEP services.

Right Idea, Wrong Result—Canada's Access to Medicines Regime

2008 ◽  
Vol 34 (4) ◽  
pp. 567-584 ◽  
Author(s):  
Paige E. Goodwin
Keyword(s):  
Low Income ◽  
Essential Medicine ◽  
Developed Countries ◽  
Access To Medicines ◽  
Production Costs ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Brand Name ◽  
Middle Income

In 2007, an estimated 33.2 million people were living with HIV, 2.5 million had become infected, and 2.1 million died from the virus. The majority of infected individuals reside in Africa, where in some countries as many as 33.4% of adults have HIV. In developed countries, effective drug therapies have reduced AIDS-related deaths by over seventy percent each year. These drugs have been so effective that over the last two years the global number of individuals dying from AIDS-related illness has actually declined. These therapies, however, are currently sold for $10,000 USD a year, a purchase price that is not feasible for low income countries where the annual health expenditure may be only $29 per person. A lack of essential medicine is not only a problem for those suffering from AIDS. Low and middle-income countries are disproportionately burdened by many additional chronic and infectious illnesses. The World Health Organization (“WHO”) estimates that one third of the world's population cannot regularly access essential medicines. The WHO cites the high cost of drugs as one of the major hurdles countries face in obtaining access to medication. However, the high cost of these brand-name medications does not reflect their minimal production costs. Drug manufacturers can produce generic versions of these drugs for as little as 1/30th of the cost of their brand-name counterparts.

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