Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings.
Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings.
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DOI：
10.1371/journal.pgph.0001309
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发表时间：
2022
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尽管全球慢性呼吸道疾病的负担日益加重，而且许多呼吸系统药物被列入世界卫生组织基本药物清单，但关于中低收入国家呼吸系统疾病治疗药物的可得性和可负担性的信息有限。2017-2019年，研究人员联系了尼泊尔巴克塔普尔、秘鲁利马和乌干达Nakaseke等全球COPD结局卓越研究地点集水区的所有公立和私立药店，以评估哮喘和COPD治疗药物的定价和可得性。我们调查了尼泊尔（95.2%为私营）、秘鲁104家（94.2%为私营）和乌干达53家（98.1%为私营）各自研究区域的所有63家药店。私立药房（93.3%）比公立药房（73.3%）更容易获得任何治疗呼吸道疾病的药物。在三个地点（尼泊尔93.7%、秘鲁86.5%和乌干达79.2%）中，任何剂型的沙丁胺醇（世卫组织- eml）单药治疗是最常用的呼吸药物，而倍氯米松（世卫组织- eml）仅在秘鲁（33.7%）和尼泊尔（22%）可用。LABA-LAMA联合疗法仅在尼泊尔提供（14.3%的受访药房）。根据几个成本指标，尼泊尔的呼吸系统药物每月治疗成本最低：每月总成本、以美元计算的药物成本与调查时国际参考价格比较的价格中位数比率，以及以工资最低的政府工作人员的日工资计算。对于间歇性哮喘的治疗（定义为100微克沙丁胺醇/沙丁胺醇吸入剂），日薪从尼泊尔和秘鲁的0.47天到乌干达的3.33天不等。呼吸系统药物的可得性和定价在低收入和中等收入国家各不相同，用于呼吸系统疾病急性护理的药物比用于长期治疗的药物更广泛。
Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017–2019 to assess pricing and availability of medications for the management of asthma and COPD. We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days’ wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days’ wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.