Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India
Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India
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DOI：
10.1136/bmjgh-2018-001379
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发表时间：
2019-03-01
影响因子：
8.1
通讯作者：
Joshi, Rohina
中科院分区：
文献类型：
--
作者：
Faruqui, Neha;Martiniuk, Alexandra;Joshi, Rohina
在低收入和中等收入国家，获得治疗慢性病的基本药物的机会有限是一个重大挑战。虽然印度是最大的仿制药生产国，但关于抗肿瘤EM的可获得性、价格和可负担性的信息很少，本研究对此进行了评估。方法采用改进的WHO/Health Action International方法，收集了33种强度特定的抗肿瘤EM和4种非癌症EM的可用性和价格数据。七家“调查主力”医院(4家公立医院和3家私立医院)和32家私营零售药店接受了调查。结果在调查的主要地区(医院和私营零售药店加在一起)，抗肿瘤药物和非癌症药物的平均可获得率分别为70%和100%。私营零售药店的抗肿瘤EM平均可获得率为38%，公立医院药店为43%，私立医院药店为71%。在零售药店，最低价格仿制药的MPR中值为0.71。对于霍奇金淋巴瘤，治疗一名体重30公斤的标准风险白血病儿童所需的化疗药物成本估计为27 850印度卢比(442美元)和17 500印度卢比(278美元)，最低收入的政府工作人员分别需要88天和55天的工资。结论调查锚地发现了大多数抗肿瘤EM，但平均可获得性低于非癌症药物；没有达到世卫组织80%的目标。与IRPS相比，新德里的药品价格相对较低。然而，在当地情况下，化疗药物的费用似乎负担不起。
Introduction Limited access to essential medicines (EMs) for treating chronic diseases is a major challenge in lowincome and middle-income countries. Although India is the largest manufacturer of generic medicines, there is a paucity of information on availability, price and affordability of anti-neoplastic EMs, which this study evaluates.Methods Using a modified WHO/Health Action International methodology, data were collected on availability and price of 33 strength-specific anti-neoplastic EMs and 4 non-cancer EMs. Seven 'survey anchor' hospitals (4 public and 3 private) and 32 private-sector retail pharmacies were surveyed. Median price ratios (MPRs) were calculated by comparing consumer prices with international reference prices (IRPs).Results On average, across survey anchor areas (hospital and private-sector retail pharmacies combined), the mean availability of anti-neoplastic EMs and noncancer medicines was 70% and 100%, respectively. Mean availability of anti-neoplastic EMs was 38% in private-sector retail pharmacies, 43% in public hospital pharmacies and 71% in private hospital pharmacies. Median MPR of lowest-priced generic versions was 0.71 in retail pharmacies. The estimated cost of chemotherapy medicines needed for treating a 30 kg child with standardrisk leukaemia was INR 27 850 (US$ 442) and INR 17 500 (US$ 278) for Hodgkin's lymphoma, requiring 88 and 55 days' wages, respectively, for the lowest paid government worker.Conclusion Most anti-neoplastic EMs are found in survey anchor areas, however, mean availability was less than non-cancer medicines; not meeting the WHO target of 80%. Medicine prices were relatively low in New Delhi compared with IRPs. However, the cost of chemotherapy medicines seems unaffordable in the local context.