August 27th 2008 1

Availability, Pricing and Affordability of Asthma Medicines 2001-2006

Presentation for Meeting on Availability, Pricing and Affordability of NCD Medicines WHO Geneva

Ntabeko Mpanza

Richard Laing

August 27th 2008 2

Outline

Introduction & Background Methodology Results

Availability Pricing Affordability

Discussion & Policy options

August 27th 2008 3

Introduction & Background Asthma was the 25th leading cause of disability

adjusted life years lost worldwide in 2001, estimated to be about 15 million DALYs per year

Beclomethasone inhalers and salbutamol inhalers are on the WHO EML.

Recent paper in Allergy by N. Ait-Khaled, D. A. Enarson, K. Bissell, N. E. Billo. Access to inhaled corticosteroids is key to improving quality of care for asthma in developing countries.

However, many patients have difficulty accessing treatment; it is a challenge for them to get their medication and so, levels of uncontrolled asthma cases remain high.

Aim: Secondary analysis of price, availability and affordability of CVD medicines in 36 developing countries that have undertaken WHO/HAI surveys

August 27th 2008 4

Methodology

WHO/HAI data Standardized data collection Prices as Median Price Ratios (MPRs) Medicines:

Salbutamol 0.1mg/dose 200 dose inhalant Beclomethasone 50ug/dose 200 dose inhalant

Secondary analysis Adjustments for inflation and purchasing power Analysis by World Bank Income Groups and WHO

regions.

August 27th 2008 5

Country list (48 surveys in 35 countries)

Low incomeChadEthiopia (2004)Ghana (2004)India-Chennai (2004)India-Haryana (2004)India-Karnataka (2004)India-Maharashtra 12 districts (2004)India-Maharashtra 4 regions (2005)India-Rajasthan (2003)India-West BengalKenya (2004)Kyrgyzstan (2005)Mali (2004)Mongolia (2004)Nigeria (2004)Pakistan (2004)Sudan-Gadarif (2006)Sudan-Khartoum (2005)Sudan-Kordofan (2006)Tajikistan (2005)Tanzania (2004)Uganda (2004)

Uzbekistan (2004)Yemen (2006)

Lower-middle incomeArmenia (2001)Cameroon (2002)China-Shandong Province (2004)China-Shanghai (2006)El-Salvador (2006)Fiji (2004)Indonesia (2004)Jordan (2004)Morocco (2004)Peru (2005) Philippines (2005)Sri Lanka (2001)Syria (2003)Tunisia (2004)

Upper-middle incomeBrazil-Rio de Janeiro (2001)Kazakhstan (2004)Lebanon (2004)Malaysia (2004)South Africa - Kwazulu Natal (2001)

High IncomeKuwait (2004)United Arab Emirates (2006)

August 27th 2008 6

Results: Availability (%)

LPG OB LPG OB LPG OB LPG OBSalb Salb Salb Salb Becl Becl Becl Becl

LI (26) 62.5% 19.5% 84.8% 45.0% 35.0% 17.3%LMI (16) 71.6% 23.1% 60.4% 68.5% 27.8% 43.3% 40.4% 28.8%UMI (5) 96.9% 82.2% 25.0% 80.0%HI (2) 43.5% 98.0% 78.0%Overall Med

Avail. N = 47) 62.5% 21.6% 82.5% 58.5% 27.8% 43.3% 35.0% 28.8%

public sector patient

availability

private pharmacies

patient availability

public sector patient

availability

private pharmacies

patient availability

Overall Availability of Beclomethasone and Salbutamol– WB Income Group Classifications

Note: The numbers next to the income categories represent the number of countries that were found in the WHO HAI website

August 27th 2008 7

Procurement and Patient PricesAdjusted for CPI and MSH prices

WHO Region Becl Salb Becl Salb Becl Salb Becl Salb

AFRO (12) 2.01 2.72 4.14 3.58 13.17

EMRO (12) 1.25 1.21 4.05 1.51 1.46 2.67

EURO (5) 3.03 3.13 3.94 3.68 3.51 4.27

PAHO (3) 6.19 4.97 4.32 3.53

SEARO (9) 4.19 3.16

WPRO (7) 4.53 2.67 4.95 7.10 4.58 6.15 9.45Overall Median Med. MPR

N = 48 1.90 2.20 4.83 3.68 1.46 3.12 6.15 9.45

public sector procurement prices public sector patient prices

Median Price Ratios of Beclomethasone and Salbutamol with surveys divided into the World

Health Organization Regions

LPG OBLPG OB

August 27th 2008 8

Median Price Ratios of Beclomethasone and Salbutamol with surveys divided into Income Group categoriesAdjusted for CPI, MSH prices and PPP

LPG OB LPG OB LPG OB LPG OB

Income group

LI (25) 3.09 13.17 4.48 6.72 4.90 5.50

LMI (15) 5.24 9.45 4.28 9.41 1.46 6.15 4.51 7.78

UMI (5) 4.27 3.40 6.21 3.43 9.85

HI (2) 1.67 4.38 2.76Overall Median Med.

MPR N = 47 3.51 9.31 4.41 7.28 1.46 6.15 4.90 7.29

Salbutamol Beclomethasone

Public sector

patient prices

Private pharmacies

patient prices

Public sector

patient prices

Private

pharmacies patient prices

August 27th 2008 9

AffordabilityDays wages of Lowest Paid Government Worker

Note: Average income often below lowest government wage Need for multiple medicines

Who Region OB LPG OB LPGAFRO (15) 4.18 2.44 8.89EMRO (14) 1.28 0.75 1.87 0.99EURO (5) 2.98 2.79PAHO (3) 1.95SEARO (8) 0.62 0.58 1.10WPRO (7) 1.41 0.74 3.23

All Regions combined N =

52 1.67 0.91 3.23 1.13

Salbutamol Beclomethasone

August 27th 2008 10

Discussion & Policy options

Availability Ensure availability of BOTH Beclo and salbutamol Increase public sector funding for Asthma medicines

Procurement Some countries: can improve on procurement prices possibly

through ADF Where procurement prices are good consider selling at cost to

private sector or through patient associations Patient prices

Lower taxes & tariffs Promote the use of generics Reduce mark-ups

August 27th 2008 11

Thank you

Please send any comments to:mpanzm@yahoo.com & laingr@who.int