Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia.
Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia.
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评估药品价格，可用性，可负担性和价格组成部分：对马来西亚毒品的影响。
DOI：
10.1371/journal.pmed.0040082
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发表时间：
2007-03-27
期刊：
影响因子：
15.8
通讯作者：
Creese, Andrew
中科院分区：
文献类型：
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作者：
Babar, Zaheer Ud Din;Ibrahim, Mohamed Izham Mohamed;Singh, Harpal;Bukahri, Nadeem Irfan;Creese, Andrew
马来西亚稳定的医疗保健系统正面临药品成本上升的挑战。为了调查这些问题，开展了一项调查，以评估药品价格、可获得性、可负担性和价格构成结构。采用了世界卫生组织（卫生组织）和国际卫生行动（卫生行动）制定的方法。从西马来西亚四个地理区域的20个公共部门设施、32个私营部门零售药房和20名配药医生收集了48种药物的价格和可得性数据。将药品价格与国际参考价格（IRPs）进行比较，得出中位数价格比。最低工资的非熟练政府工作人员的日工资被用来衡量药品的负担能力。在整个供应链中收集价格成分数据，并确定加价、税收和其他分销成本。在私人药店，创新品牌（IB）的价格是创新产品价格的16倍，仿制药价格是创新产品价格的6.6倍。在配药医生诊所，创新品牌的数字是15倍，仿制药是7.5倍。配药医生对IBs的加价高达50%-76%，对仿制药的加价高达316%。零售药房的加价也很高，IBs和仿制药的加价分别为25% - 38%和100%-140%。在免费提供药物的公共部门，即使是《国家基本药物清单》上的药物，可获得性也很低。对于消化性溃疡和高血压一个月的治疗，人们必须在私营部门支付大约一周的工资。自由市场本质上并不控制药品价格，因此需要价格监测和控制机制。仿制药的加价高于IBs。在不控制加价的情况下降低基本价格可能会增加零售商和配药医生的利润，而不会降低最终用户支付的价格。为了增加可及性和可负担性，需要促进非专利药物并改善公共部门药物的可得性。药物价格和可获得性数据收集自西马来西亚公共部门设施、私营部门零售药房和配药医生。仿制药的加价高于创新品牌。世界卫生组织表示，世界上三分之一的人无法获得所需的药物。造成这一问题的一个重要原因是，价格往往太高，人们或政府资助的卫生系统负担不起。在发展中国家，大多数需要药品的人必须自掏腰包。在药品费用由卫生系统承担的地方，药品支出是卫生保健总预算的主要部分。各国政府使用各种方法试图控制药物成本，确保基本药物是人们负担得起的，不会定价过高。根据“自由市场经济学”理论，商品和服务的成本是由买卖双方的相互作用决定的，而不是由政府干预决定的。然而，自由市场经济并不能很好地控制药品，特别是新药的成本，因为新药受到专利法的保护，专利法在法律上禁止其他人在特定时期内制造、使用或销售这种药物。因此，如果没有政府的干预，就无法帮助压低价格。马来西亚是一个中等收入国家，拥有相对有效的公共卫生系统，但它正面临药品成本迅速上升的问题。在马来西亚，药品价格由自由市场经济决定，不受政府控制。预计政府医院将免费提供药品，但很大一部分药品由病人支付，他们直接从私人药房或开处方的医生那里购买。有证据表明，马来西亚患者难以获得所需的药物，而费用是一个重要因素。因此，撰写这篇论文的研究人员想要检查马来西亚不同药物的成本，以及它们从不同来源的可用性和可负担性。在这个研究项目中，研究了48种药物，其中28种属于世界卫生组织根据全球疾病负担确定为“基本药物”的“核心清单”。其余20项反映了马来西亚本身的保健需求。每种药物的费用是从马来西亚四个不同地区的政府医院、私人药房和配药医生那里收取的。收集了“创新品牌”（由原始专利持有人制造）和“非专利”品牌（与创新品牌等效的药物，一旦创新品牌不再拥有独家专利，由另一家公司生产）的数据。将药品价格与国际参考价格（IRP）进行比较，国际参考价格是非营利制药公司向发展中国家提供的平均价格。最后，研究人员还将药品的成本与日工资进行了比较，以计算出他们的“负担能力”。研究人员发现，无论药品的来源如何，价格平均都远远高于国际参考价格，从通过公立医院获得的创新品牌的IRP的2.4倍到通过私人药房获得的创新品牌的IRP的16倍不等。药品的可得性也很差，平均只有25%的非专利药品可通过公共部门获得。所研究的许多药物的可负担性也很差。例如，一个月的雷尼替丁（一种治疗胃溃疡的药物）的供应相当于一个低收入政府工作人员三天的工资，一个月的氟西汀（一种抗抑郁药）的供应将花费大约26天的工资。这些结果表明，基本药物在马来西亚非常昂贵，并不是普遍可用。许多人将无法支付基本药物的费用。马来西亚的药品成本似乎比印度和斯里兰卡地区高得多，尽管研究人员并没有试图收集数据来进行国际比较。马来西亚的高成本和低可用性可能是缺乏政府监管的结果。总的来说，研究结果表明，政府应该建立机制，防止药品制造商过度提价，从而确保更多人获得基本药物。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.0040082访问这些网站。世界卫生组织关于改善药品可及性的信息可从卫生行动国际获得药品价格信息维基百科有一个关于专利的条目（一种知识产权，通常用于阻止其他公司销售新发明的药物）。（维基百科是一个任何人都可以编辑的互联网百科全书。）被忽视疾病药物倡议是公共组织之间的一项国际合作，旨在为患有被忽视疾病的人开发药物
Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. The methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required. Drug price and availability data were collected from West Malaysian public sector facilities, private sector retail pharmacies, and dispensing doctors. Mark-ups were higher on generic drugs than on innovator brands. The World Health Organization has said that one-third of the people of the world cannot access the medicines they need. An important reason for this problem is that prices are often too high for people or government-funded health systems to afford. In developing countries, most people who need medicines have to pay for them out of their own pockets. Where the cost of drugs is covered by health systems, spending on medicines is a major part of the total healthcare budget. Governments use a variety of approaches to try to control the cost of drugs and make sure that essential medicines are affordable and not overpriced. According to the theory of “free market economics,” the costs of goods and services are determined by interactions between buyers and sellers and not by government intervention. However, free market economics does not work well at containing the costs of medicines, particularly new medicines, because new medicines are protected by patent law, which legally prevents others from making, using, or selling the medicine for a particular period of time. Therefore, without government intervention, there is nothing to help to push down prices. Malaysia is a middle-income country with a relatively effective public health system, but it is facing a rapid rise in drug costs. In Malaysia, medicine prices are determined by free-market economics, without any control by government. Government hospitals are expected to provide drugs free, but a substantial proportion of medicines are paid for by patients who buy them directly from private pharmacies or prescribing doctors. There is evidence that Malaysian patients have difficulties accessing the drugs they need and that cost is an important factor. Therefore, the researchers who wrote this paper wanted to examine the cost of different medicines in Malaysia, and their availability and affordability from different sources. In this research project, 48 drugs were studied, of which 28 were part of a “core list” identified by the World Health Organization as “essential drugs” on the basis of the global burden of disease. The remaining 20 reflected health care needs in Malaysia itself. The costs of each medicine were collected from government hospitals, private pharmacies, and dispensing doctors in four different regions of Malaysia. Data were collected for the “innovator brand” (made by the original patent holder) and for “generic” brands (an equivalent drug to the innovator brand, produced by a different company once the innovator brand no longer has an exclusive patent). The medicine prices were compared against international reference prices (IRP), which are the average prices offered by not-for-profit drug companies to developing countries. Finally, the researchers also compared the cost of the drugs with daily wages, in order to work out their “affordability.” The researchers found that, irrespective of the source of medicines, prices were on average very much higher than the international reference price, ranging from 2.4 times the IRP for innovator brands accessed through public hospitals, to 16 times the IRP for innovator brands accessed through private pharmacies. The availability of medicines was also very poor, with only 25% of generic medicines available on average through the public sector. The affordability of many of the medicines studied was again very poor. For example, one month's supply of ranitidine (a drug for stomach ulcers) was equivalent to around three days' wages for a low-paid government worker, and one month's supply of fluoxetine (an antidepressant) would cost around 26 days' wages. These results show that essential drugs are very expensive in Malaysia and are not universally available. Many people would not be able to pay for essential medicines. The cost of medicines in Malaysia seems to be much higher than in areas of India and Sri Lanka, although the researchers did not attempt to collect data in order to carry out an international comparison. It is possible that the high cost and low availability in Malaysia are the result of a lack of government regulation. Overall, the findings suggest that the government should set up mechanisms to prevent drug manufacturers from increasing prices too much and thus ensure greater access to essential medicines. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040082. Read a related PLoS Medicine Perspective article by Suzanne Hill Information is available from the World Health Organization on Improving Access to Medicines Information on medicine prices is available from Health Action International Wikipedia has an entry on Patent (a type of intellectual property that is normally used to prevent other companies from selling a newly invented medicine). (Wikipedia is an internet encyclopedia anyone can edit.) The Drugs for Neglected Diseases Initiative is an international collaboration between public organizations that aims to develop drugs for people suffering from neglected diseases
影响因子：
--
作者：
Bloor, K;Maynard, A;Freemantle, N
通讯作者：
Freemantle, N