Niëns LM, Cameron A, Van de Poel E, Ewen M, Brouwer
WBF, et al. (2010) Quantifying the Impoverishing Effects of Purchasing
Medicines: A Cross-Country Comparison of the Affordability of Medicines
in the Developing World. PLoS Med 7(8):
e1000333.
doi:10.1371/journal.pmed.1000333
Editors' Summary
Background
In
recent years, the international community has prioritized access to
essential medicines, which has required focusing on the accessibility,
availability, quality, and affordability of life-saving medicines and
the development of appropriate data and research agendas to measure
these components. Determining the degree of affordability of medicines,
especially in low- and middle-income countries, is a complex process as
the term affordability is vague. However, the cost of medicines is a
major public health issue, especially as the majority of people in
developing countries do not have health insurance and medicines freely
provided through the public sector are often unavailable. Therefore,
although countries have a legal obligation to make essential medicines
available to those who need them at an affordable cost, poor people
often have to pay for the medicines that they need when they are ill.
Consequently, where medicine prices are high, people may have to forego
treatment or they may go into debt if they decide to buy the necessary
medicines.
Why Was This Study Done?
The
researchers wanted to show the impact of the cost of medicines on
poorer populations by undertaking an analysis that quantified the
proportion of people who would be pushed into poverty (an income level
of US$1.25 or US$2 a day) because their only option is to pay
out-of-pocket expenses for the life-saving medicines they need. The
researchers referred to this consequence as the “impoverishing effect of
a medicine.”
What Did the Researchers Do and Find?
The
researchers generated “impoverishment rates” of four medicines in 16
low- and middle-income countries by comparing households' daily per
capita income before and after (the hypothetical) purchase of one of the
following: a salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg
cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab. This
selection of drugs covers the treatment/management of three chronic
diseases and one acute illness. The cost of each medicine was taken from
standardized surveys, which report median patient prices for a
selection of commonly used medicines in the private sector (the
availability of essential medicines in the public sector is much lower
so many people will depend on the private sector for their medicines)
for both originator brand and lowest priced generic products. If the
prepayment income was above the US$1.25 (or US$2) poverty line and the
postpayment income fell below these lines, purchasing these medicines at
current prices impoverishes people.
According
to the results of this analysis, a substantial proportion (up to 86%)
of the population in the countries studied would be pushed into poverty
as a result of purchasing one of the four selected medicines.
Furthermore, the lowest priced generic versions of each medicine were
generally substantially more affordable than originator brand products.
For example, in the Philippines, purchasing originator brand atenolol
would push an additional 22% of the population below US$1.25 per day
compared to 7% if the lowest priced generic equivalent was bought
instead. In effect, purchasing essential medicines for both chronic and
acute conditions could impoverish large numbers of people, especially if
originator brand products are bought.
What Do These Findings Mean?
Although
the purchasing of medicines represents only part of the costs
associated with the management of an illness, it is clear that the high
cost of medicines have catastrophic effects on poor people. In addition,
as the treatment of chronic conditions often requires a combination of
medicines, the cost of treating and managing a chronic condition such as
asthma, diabetes, and cardiovascular disease is likely to be even more
unaffordable than what is reported in this study. Therefore concerted
action is urgently required to improve medicine affordability and
prevent poor populations from being pushed further into poverty. Such
action could include: governments, civil society organizations, and
others making access to essential medicines more of a priority and to
consider this strategy as an integral part of reducing poverty; the
development, implementation, and enforcement of sound national and
international price policies; actively promoting the use of quality
assured, low-cost generic drugs; ensuring the availability of essential
medicines in the public sector at little or no charge to poor people;
establishing health insurance systems with outpatient medicine benefits;
encouraging pharmaceutical companies to differentially price medicines
that are still subject to patent restrictions.
