The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries
The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries
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DOI：
10.3389/fphar.2019.01375
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发表时间：
2019-11-19
影响因子：
5.6
通讯作者：
Hasan, Syed Shahzad
中科院分区：
文献类型：
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作者：
Babar, Zaheer-Ud-Din;Ramzan, Sara;Hasan, Syed Shahzad
背景：世界人口的三分之一无法获得基本药物。糖尿病需要长期治疗，这会产生巨大的卫生保健费用，从而影响可及性和可负担性。本研究旨在评估17个国家私营初级保健药房中用于治疗糖尿病的四种基本药物的可得性、价格和可负担性。方法：采用世界卫生组织/卫生行动国际（WHO/HAI）的一种方法，从17个国家的51家初级保健药房获得四种基本糖尿病药物的可负担性、可获得性和价格数据。被调查的国家是阿曼、卡塔尔、沙特阿拉伯、阿拉伯联合酋长国、中国、约旦、俄罗斯、亚美尼亚、孟加拉国、埃及、格鲁吉亚、印度、巴基斯坦、斯里兰卡、阿富汗、尼泊尔和坦桑尼亚。国际参考价格和工资最低的非熟练政府工作人员的日收入被用作比较指标。价格用外汇汇率和购买力平价换算成美元。我们按世卫组织区域分组和国家一级比较了糖尿病药物创新品牌（IB）和价格最低的仿制药（LPG）的可负担性和可获得性模式和价格。结果：价格最低的二甲双胍仿制药500 mg的总平均可获得性最高（>= 80%）。在接受调查的17个国家中，胰岛素100 IU/ml的总平均可用性仅为36.21% (IBs和LPG)，其中IB比LPG更常见（50%对26%）。低收入国家的患者需要比高收入国家的患者花费更多的钱来购买1个月的IB胰岛素供应。日工资：2.37 vs. 0.46, p = 0.038)。在大多数被调查的国家中，房价比率的中位数低于3。经购买力平价调整后，胰岛素100 IU/ml和二甲双胍500 mg的IB治疗30天价格最高的国家分别是孟加拉国（80.21美元）和坦桑尼亚（4334.17美元）。结论：通用型胰岛素可得性较差；高收入国家比低收入国家更能负担胰岛素IB。大多数液化石油气价格合理，工资最低的非熟练工人也负担得起。
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 Organization/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 and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-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 100 IU/ml and metformin 500 mg 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.