Websites reporting medicine prices: a comparative analysis
Transcript of Websites reporting medicine prices: a comparative analysis
Websites reporting medicine prices:
a comparative analysis
Ms Saskia van Dongen 1
1 Department of Pharmaceutical Sciences, Utrecht University, the Netherlands; Intern at Essential Medicines and Pharmaceutical Policies department, World Health Organization, Geneva, Switzerland
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 2
Internship period: 1 March 2010 to 31 August 2010
Revision of report 1 September 2010 to 31 December 2010
WHO Examiners: Ms Alexandra Cameron Dr Richard Laing
Utrecht University Examiner: Dr Aukje Mantel-Teeuwisse
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EXECUTIVE SUMMARY
In recent years, many commercial and non-commercial websites reporting medicine price have
become available on the internet. However, both the quality of these websites, and the availability
of descriptive information about the prices to allow appropriate interpretation, can limit their
usefulness. I conducted a qualitative analysis of 71 non-commercial, publicly available websites
from both national (n=50) and international (n=21) price sources. Of all websites the quality of the
site in general and the quality of the price data reported were assessed, using general and price
specific criteria. Most of the websites were fast and user-friendly, but many received a low score
for important criteria such as publication of the date of the last update of site and price
information, and search ability within the price information. Various types of medicine prices were
reported (e.g. ex-factory, procurement, wholesale, reimbursement, retail/patient prices) therefore
a specific checklist for every price type was designed to assess the comprehensiveness of the
price information. It was found that the websites often published price information that lacked key
information to perform valid international price comparisons. For example, to improve the
interpretability of price data it is recommended that websites publish information on the
components of each price (e.g. if VAT/GST is included or not, and if so the amount of the tax).
Other recommendations based on the results included the listing of medicines by INN name
(rather than by brand name) and the exchange rate to US $ applicable at the date of price
information posting.
Secondly, a quantitative analysis of medicine prices found on national websites was conducted to
assess the feasibility of comparing web-based medicine price information from different sources.
The analysis was performed on the prices of 7 medicines selected for their wide range of
therapeutic effects and the expected high availability of price data (e.g. amitriptyline 25mg,
atenolol 50mg, ciprofloxacin 500mg, glibenclamide 5mg, omeprazole 20mg, salbutamol
100mcg/dose and simvastatin 20mg). Actual price information can be compared across various
price sources but a lack of comparability of price data components across sites limits the
usefulness of these price comparisons. Therefore data was adjusted (e.g. taxes and other fees
excluded) where possible to improve the comparability of price data reported from different
sources; the seven medicine comparisons conducted in this study showed however that this is
very demanding work.
More extensive comparisons using all national websites would be even more demanding;
therefore, the use of international websites such as the Hungarian CEDD website should be
considered for price comparisons. In addition, although a comparison of prices is possible using a
small selection of national websites, a reasonable outcome can only be expected when using
multiple sites. However, large variations were still found in the prices of individual medicines; this
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variation was often greatest for procurement, reimbursement and retail/patient prices. While some
price variation would be expected due to comparability issues, these and other national issues
alone would not account for the large scale price variation found in the 7 medicines comparison
study. With the exception of Tamil Nadu procurement prices (reporting 5 out of the 7 medicines),
there was no consistency as to which website reported the lowest prices. In addition, there was
little correlation between national GDP (Gross Domestic Product) per capita and prices. Thus, it
can be concluded that prices for the same products vary widely across countries, even within
similar countries (e.g. similar WHO region and country income class).
Looking at the price comparisons in general as well as their results it is surprising that although
medicine price information appears to be widely available on the internet, great variations in
prices still exist.
As a last step, two brand medicines were compared to their generic therapeutic equivalent
substance to investigate the potential cost savings of generic therapeutic substitution. Lipitor
20mg (atorvastatin) was compared to simvastatin 20mg, while Nexium 20mg (esomeprazole) was
compared to omeprazole 20mg. it was seen that all of the prices of Lipitor and Nexium were far
higher. In fact, differences up to 214-fold for Lipitor compared to simvastatin and differences up to
41.1 for Nexium compared to omeprazole were reported. While Lipitor and Nexium may be
marginally more effective when the same doses are compared these differences are in the range
of 20 to 50 % and not many fold differences as were found for the prices. These substantial price
variations clearly showed the potential cost savings of generic therapeutic substitution of
simvastatin for Lipitor and omeprazole for Nexium.
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Table of Contents
EXECUTIVE SUMMARY ..................................................................................................................3
I - INTRODUCTION ....................................................................................................................... 11
II - BACKGROUND ........................................................................................................................ 11
III - OBJECTIVE / HYPOTHESIS / EXPECTED OUTCOMES ...................................................... 16
IV - METHODS .............................................................................................................................. 17
IV - 1. Literature review .............................................................................................................. 17
IV - 2. Identification of websites ................................................................................................. 17
IV - 3. Qualitative analysis of websites ...................................................................................... 18
Criteria for assessing site quality for undertaking international price comparisons .............. 18
Criteria for assessing price information for undertaking international price comparisons .... 19
IV - 4. Quantitative analysis of price information ....................................................................... 22
V - RESULTS ................................................................................................................................. 25
V - 1. Qualitative Analysis .......................................................................................................... 25
V - 1.1 NATIONAL WEBSITES ............................................................................................. 27
V - 1. 2 PRICE GUIDES........................................................................................................ 49
V - 2. Quantitative Analysis ........................................................................................................ 61
Amitriptyline 25mg capsules/tablets ..................................................................................... 63
Atenolol 50mg capsules/tablets ............................................................................................ 67
Ciprofloxacin 500mg capsules/tablets .................................................................................. 71
Glibenclamide 5mg capsules/tablet. ..................................................................................... 77
Omeprazole 20mg capsules/tablets ..................................................................................... 81
Salbutamol 100mcg/dose inhaler ......................................................................................... 87
Simvastatin 20mg capsules/tablets ...................................................................................... 91
Comparison of therapeutic equivalent substances .................................................................... 97
Atorvastatin 20mg vs. Simvastatin 20mg.............................................................................. 97
Esomeprazole 20mg vs. Omeprazole 20mg ........................................................................ 99
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VI - DISCUSSION ........................................................................................................................ 101
VII - RECOMMENDATIONS ........................................................................................................ 109
Recommendations for webmasters on general site quality ..................................................... 109
Recommendations for users of websites for price comparisons ............................................. 112
Recommendations for users of websites for price comparisons ............................................. 113
VIII - CONCLUSION .................................................................................................................... 115
REFERENCES ............................................................................................................................ 117
ANNEX I Descriptive characteristics for websites reporting medicine prices ......................... 119
ANNEX II .................................................................................................................................. 120
NATIONAL MEDICINE PRICE SOURCES.............................................................................. 120
ANNEX IIIa ............................................................................................................................... 123
INTERNATIONAL MEDICINE PRICE GUIDES ....................................................................... 123
ANNEX IIIb ............................................................................................................................... 124
INTERNATIONAL MEDICINE PRICELIST SOURCES ........................................................... 124
ANNEX IV Qualitative Country Annex ..................................................................................... 125
African Regional Office (AFRO) ............................................................................................... 125
SOUTH AFRICA ................................................................................................................. 125
ANNEX V Qualitative Country Annex ...................................................................................... 131
The Americas Regional Office (AMRO) ................................................................................... 131
BRAZIL ............................................................................................................................... 131
CANADA ............................................................................................................................. 133
UNITED STATES ................................................................................................................ 137
ANNEX VI Qualitative Country Annex ..................................................................................... 145
Eastern Mediterranean Regional Office (EMRO) .................................................................... 145
BAHRAIN ............................................................................................................................ 145
IRAN.................................................................................................................................... 147
JORDAN ............................................................................................................................. 149
LEBANON ........................................................................................................................... 151
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MOROCCO ......................................................................................................................... 153
OMAN ................................................................................................................................. 155
SUDAN ............................................................................................................................... 157
TUNISIA .............................................................................................................................. 159
ANNEX VII Qualitative Country Annex .................................................................................... 161
European Regional Office (EURO) .......................................................................................... 161
AUSTRIA ............................................................................................................................ 161
BELGIUM ............................................................................................................................ 163
CZECH REPUBLIC ............................................................................................................. 165
DENMARK .......................................................................................................................... 169
FINLAND ............................................................................................................................. 173
FRANCE ............................................................................................................................. 175
GERMANY .......................................................................................................................... 179
HUNGARY .......................................................................................................................... 181
IRELAND ............................................................................................................................ 183
ITALY .................................................................................................................................. 185
LATVIA ................................................................................................................................ 187
LITHUANIA ......................................................................................................................... 189
NETHERLANDS ................................................................................................................. 191
NORWAY ............................................................................................................................ 193
POLAND ............................................................................................................................. 199
PORTUGAL ........................................................................................................................ 201
SLOVAKIA .......................................................................................................................... 205
SLOVENIA .......................................................................................................................... 207
SPAIN ................................................................................................................................. 209
SWEDEN ............................................................................................................................ 213
UNITED KINGDOM ............................................................................................................ 215
ANNEX VIII Qualitative Country Annex ................................................................................... 225
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South East Asia Regional Office (SEARO) .............................................................................. 225
INDIA................................................................................................................................... 225
ANNEX IX Qualitative Country Annex ..................................................................................... 229
Western Pacific Regional Office (WPRO) ................................................................................ 229
AUSTRALIA ........................................................................................................................ 229
NEW ZEALAND .................................................................................................................. 231
ANNEX X Qualitative Price Guides Annex .................................................................................. 233
Global Fund to fight AIDS, Tuberculosis and Malaria & AIDS Medicines and Diagnostic Services ................................................................................................................................... 233
ANNEX XI Qualitative Price Guides Annex ................................................................................. 237
Clinton Foundation & Médecins Sans Frontières .................................................................... 237
Clinton Foundation .............................................................................................................. 237
Médecins Sans Frontières (Doctors Without Borders) ....................................................... 239
ANNEX XII Qualitative Price Guides Annex ................................................................................ 241
Common European Drug Database, Management Sciences for Health & Österreichisches Bundesinstitut für Gesundheitswesen...................................................................................... 241
Common European Drug Database ................................................................................... 241
Österreichisches Bundesinstitut für Gesundheitswesen .................................................... 245
ANNEX XIII Qualitative Price Guides Annex ............................................................................... 247
International Trade Centre, WHO databases, Health Action International & UNICEF ............ 247
International Trade Centre .................................................................................................. 247
WHO databases ................................................................................................................ 248
World Health Organization AFRO ....................................................................................... 249
Health Action International .................................................................................................. 255
UNICEF ............................................................................................................................... 259
ANNEX XIV: Amitriptyline 25mg cap/tab ..................................................................................... 262
ANNEX XV: Atenolol 50mg cap/tab............................................................................................. 274
ANNEX XVI: Ciprofloxacin 500mg cap/tab .................................................................................. 286
ANNEX XVII: Glibenclamide 5mg cap/tab ................................................................................... 300
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ANNEX XVIII: Omeprazole 20mg cap/tab ................................................................................... 312
ANNEX XIX: Salbutamol inhaler 100mcg/dose ........................................................................... 326
ANNEX XX: Simvastatin 20mg cap/tab ....................................................................................... 340
ANNEX XXI: Atorvastatin 20mg cap/tab...................................................................................... 354
ANNEX XXII: Esomeprazole 20mg cap/tab ................................................................................ 360
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I - INTRODUCTION Medicine prices are an important public health issue as concerns about constrained healthcare
resources, particularly in developing countries, remain. Further, the majority of populations in low-
and middle-income countries have to pay for medicines out-of-pocket, and as such unaffordable
prices can be a significant barrier to accessing appropriate care. (1, 2) Transparent information
about medicine prices is important to inform decision-making on the part of governments, patients
and others. For example, access to national medicine price information can assist governments in
purchase negotiations and can be used for external reference pricing, whereby the criterion (or
one of the criteria) for setting the national regulated price is based on the prices in other
countries.
Systematic comparisons of medicine prices are lacking and as a result data needed to guide
national policies on medicine pricing are insufficient. (1, 2) Western countries have been forced to
contain health spending by the recent economic crisis and improved management of medicine
prices is an important contribution to containing health costs. For example, the PHARMAC
system in New Zealand has shown that it is possible to manage medicine prices and at the same
time improve access to medicines. (2) In addition, information on medicine prices, especially
reimbursement prices, should be easily available for consumers since these expenses directly
affect their healthcare. (3, 4)
An increasing number of national and international websites reporting medicine price information
is currently available on the internet. Although the publication of these prices is a great step
forward in improving transparency between, in particular, individual countries; the usefulness of
the price information is sometimes limited by the general site quality as well as the absence of
detailed price characteristics to allow appropriate interpretation of the published prices.
To assess the quality of both the site in general and the price information specific, a
comprehensive review of medicine prices available on the internet will be conducted. Many
organizations and individuals have previously reviewed other health-related informational
websites including websites of Medicine Regulatory Authorities (MRA). A study on price reporting
websites has however, to date not been conducted. This new study will investigate the availability
of medicine price information and analyse the price information reported in a qualitative and
quantitative way.
Websites from national and international sources reporting non-commercial medicine price
information will be identified through web based searches. On the thus identified websites a
comparative analysis will be performed by scoring the websites using sets of predefined criteria
that address general and price-specific issues. Lastly, a quantitative analysis will be performed for
selected medicines to assess whether the identified websites are suitable for international price
comparisons.
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As a result, the interpretability of the price data for the user is assessed, thereby providing insight
into the usefulness of web-based medicine price data for international price comparisons. Finally,
recommendations for webmasters, price database authors and users of the websites will be
provided.
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II - BACKGROUND
The internet can be a valuable tool for patients, health professionals and pharmaceutical
companies to obtain information on healthcare, including pharmaceutical products. One important
aspect of pharmaceuticals that can be found on the internet is information on medicine prices.
However the quality of information on the internet is variable and must be interpreted with
caution. In recent years there has been an emergence of many types of medicine price
information on websites from various sources including national and international websites as
well as commercial websites. These price reports are a great step forward in improving
transparency; however the usefulness of the information can be limited by the general quality of
the website as well as the unavailability of information to allow appropriate interpretation of the
prices reported. This is of importance since only good quality websites allow users to properly
interpret and utilize the reported medicine prices. (5, 6) Further, these websites are being
consulted for international price comparisons even when that is not their primary objective (most
national websites reporting medicine prices were not created for conducting international
comparisons). Comprehensiveness of the descriptive information accompanying price data
should therefore be considered as a major criterion when evaluating websites, regardless of the
publisher and the website's primary objective. The quality of the website, however, cannot be
seen as an indication of the quality of the price information and vice versa. Therefore both
general and price-specific criteria are needed to conduct a thorough evaluation of a website
reporting medicine prices.
Another issue related to web-based medicine price information is the degree of comparability
across sources. This is particularly relevant in the context of external reference pricing, as many
countries are using websites as a source of price data. A key issue affecting comparability of
medicine prices is the lack of information about the price components or add-on costs that are
included or excluded from the price. For example, purchase prices may be Ex-Factory or may
include insurance and freight costs (CIF), while patient prices may or may not include Value
Added Tax. Another problem is the broad range of products reported for a single medicine, for
example, different manufacturers, dosage forms, strengths and package sizes. (3, 4) A further
issue is that the market dynamics of a medicine differ from one country to another. In addition, the
add-on costs (e.g. mark-ups, duties and taxes) can be different across countries and influence
the comparison. (7) Despite these challenges, several international price comparisons have been
conducted. (8) For example, in 2008 a study conducted in Norway (9) compared medicine prices
in this country with those in nine other countries (Austria, Belgium, Denmark, Finland, Germany,
Ireland, the Netherlands, Sweden and the United Kingdom). A range of strategies were used to
improve the comparability of price across countries. Volume-weighted average prices per dose
were calculated for each substance, as were the wholesale and pharmacy margins. Price indices
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were calculated for all substances, patent protected substances, and non-patent protected
substances. The statistical significance of the cross-country price differences was tested with
regression analysis, where various factors such as pack size were controlled for. (9)
To improve the availability of comparable medicine price information, WHO and Health Action
International have developed a standard survey methodology for collecting data on medicine
prices and availability at the facility level (as well as public procurement prices which are usually
collected centrally). (7) Through the application of standard methods and commonality in the
medicines used across countries, comparability of the results is enhanced and international
comparisons are possible. (8) While the WHO/HAI database of medicine price information
remains an important web-based resource, other web-based sources of quoted medicine prices
are also being used for comparisons and as such, an assessment of the degree of comparability
across these various sources is warranted.
To date no comprehensive review of medicine prices available on the internet has been
conducted. In fact, limited work has been undertaken to assess web-based pharmaceutical
information in general. Studies undertaken by the WHO in 2001 and 2009 have reviewed
websites of Medicines Regulatory Authorities (MRAs). But these studies were primarily designed
for information management directors and website administrators of MRAs and did not address
the issue of pharmaceutical prices. (5, 6)
Criteria for assessing websites reporting medicine prices
Many organizations and individuals have published criteria to evaluate health-related information
on the internet. (3, 5, 10, 11) As concluded by Kim et al. (3, 5, 10, 11) many authors agree on key
criteria for assessing health-related websites. The most frequently-cited criteria are those dealing
with content, design and aesthetics of the site, disclosure of authors, sponsors or developers,
currency of information (includes frequency of update, freshness, maintenance of site), authority
of source, ease of use and access, and accessibility and availability. However, since most of the
criteria for health-related sites are general, they can only be used to assess the general quality of
pricing websites. The evaluation of medicine pricing websites also needs more specific criteria
related to the price data being reported. However, while several studies have described the
challenges of comparing medicine prices from different sources, they do not suggest criteria for
evaluating the quality of price data from different sources.(3, 4, 12)
As part of the analysis of national MRA websites, a set of criteria was developed for assessing
site quality. These criteria have some relevance to websites reporting medicine prices and are a
useful starting point for the development of an assessment framework. The first (pilot) study on
the evaluation of medicine regulatory websites was done by Jambert (5) in 2001. Her general
purpose was to propose a WHO Model website as a guide for MRAs in order to offer internet
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users improved quality and increased availability of health information. (5, 6) Jambert (5)
developed a list of criteria designed to serve as the 'gold standard' to analyse MRA websites,
consisting of 6 general and 18 specific criteria. These 24 criteria were set up as a checklist to
assess the quality of information on a MRA website. A scoring system ranging from 0 to 2
(0=inadequate, 1=intermediate, 2=good) was used to weight each criterion. The general criteria
used were: user friendliness, navigability, speed, site map, search and update. The specific
criteria developed focussed on the provided information about the MRA organization itself,
available medicinal products in the country, the distribution chain of pharmaceuticals, and about
some basic statistics in country profile (e.g. medicine consumption data, population data, income
statistics, and health and health system statistics).
Vitry et al. (11) followed up on this study in 2008 and studied the MRA websites from USA,
Canada, UK, France, Australia, New Zealand, and the European Medicines Agency (EMEA) in
order to assess the availability of information. However, the criteria used to score the websites,
while based on those of Jambert, differed from the 2001 study. They organized 16 specific criteria
into 3 domains: information on marketed medicines, information on assessment of medicines and
information on medicine safety. No general assessment of website quality was made.
In 2009 Cornips et al. (6) updated the study conducted by Jambert (5) and reviewed the progress
made on MRA websites between 2001 and 2009. They used the criteria developed by Jambert in
2001 to assess the quality and types of information provided on the websites. The only change
they made in the general criteria was a separate assessment of language as a criterion (this was
previously grouped under user-friendliness). Cornips et al. added this criterion to emphasize the
importance of the availability of information in both English and the national language.
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III - OBJECTIVE / HYPOTHESIS / EXPECTED OUTCOMES
This study investigates the extent and nature of medicine price information available on the
internet to serve multiple purposes. The interpretability of the price data for the user is assessed,
thereby providing insight into the usefulness of web-based medicine price data for international
price comparisons. As a first step, a comprehensive search was conducted to identify websites
from national and international sources that contain non-commercial medicine price information.
Websites that display factory price lists and commercial website selling to individuals were
considered to be outside the scope of the study and were therefore excluded from the search. A
series of descriptive characteristics was used to classify the websites and the type of medicine
price information they contain. Secondly, a comparative analysis was performed by scoring
websites using a set of criteria that address both general and price-specific issues. Finally, a
quantitative analysis was carried out for selected medicines to assess the degree of comparability
across various sources of price information.
The primary outcome of the study is a comprehensive list of national/international websites
reporting medicine price information with a comparative analysis that will enable better
interpretation of the various sources by their users. The comparative analysis also includes an
assessment of the feasibility of comparing web-based medicine pricing information from different
sources. In order to achieve the outcomes described above, the following research questions
were investigated:
o Which countries have a website with information on medicine prices? What other not-for-
profit sources of medicine price information are available?
o What kind of websites display information on medicine prices (national, international,
commercial websites)?
o What type of medicine price information is available on the internet (manufacturer,
supplier, procurement, wholesale, reimbursement, patient)?
o What type of product and supplier characteristics is provided to accompany the price
information (e.g. quality certifications)?
o To what degree can cross-country price comparisons be made by using price information
available on the internet?
As external reference pricing is often based on price data available on websites, a secondary
outcome of this study is to provide general guidance on what to look for when obtaining price
information of websites for the purpose of international price comparisons. Based on this,
recommendations will be given on what to take in consideration when scoping for external
reference prices. This advice could also serve as guidance for publishers of medicine prices that
want to make their website useful for international price comparisons.
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IV - METHODS
IV - 1. Literature review
As a first step, a literature review was conducted to support the development of criteria for
assessing websites reporting medicine prices. PubMed and WHOLIS databases (WHO library
database) were used to identify relevant id literature by using one or more of the following search
terms: health website, medicine price, drug costs (MeSH term), comparative analysis, criteria for
evaluation, website evaluation, price evaluation, price comparisons, country comparisons,
reimbursement, wholesale, patient.
IV - 2. Identification of websites
To identify websites reporting medicine prices a comprehensive search was conducted. The
initial scope for this identification process was web-based searches through search engine
Google (www.google.com). The outcome of this search was a list of websites from various
sources, including governments (MRA, Ministry of Health (MoH)), health organizations,
foundations, global agencies and health insurance agencies. The following terms were searched
in English, French and Spanish:
� medicine prices / prix des medicaments / precios de los medicamentos
� country names
� ministry of health / ministère de santé / ministerio de salud / saude
� health insurance / assurance maladie / seguro de salud
� pharmaceutical agency / pharmaceutiques agence / agencia farmacéutica
� medicine database / medicine database / base de datos de medicina
� pharmacy / pharmacie / farmacia
� wholesaler / grossistes / mayorista
� medicine authority regulator / autoridad de medicamentos / autorité des
medicaments;
Other searches included identification through WHO contacts, which resulted in a list of price
sources on existing websites that was already published on the website of Health Action
International. A number of websites found through the Google searches was already present on
this list; however a few new websites were added to the list.
All websites identified through this search were included in the qualitative and/or quantitative
analysis based on a set of defined criteria. Only current price reporting websites were included,
meaning that they published recent price information (2008 to 2010). Excluded from analysis
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were websites with manufacturer or retail price lists and commercial websites that sell to
individuals. In addition to the general exclusion criteria, one specific criterion was added to select
appropriate sites for the qualitative analysis. Only publicly available websites were included;
websites asking for an entry fee to access price information were excluded.
IV - 3. Qualitative analysis of websites
A series of descriptive characteristics was used to classify the websites and the type of medicine
price information they contain (e.g. ex-factory, procurement, wholesale, reimbursement, retail).
The websites were classified according to their source (e.g. government, international non-profit)
in order to assess if quality varies between sources (Annex I).
Once the websites were classified, a comparative analysis was performed by scoring the national
websites using a set of criteria that addressed both general and price-specific issues. The scoring
system developed attributes specific scores based on pre-defined site characteristics to minimize
individual interpretation. The scoring system used to assess site quality is provided in Table 1. In
case of questionable findings, Ms. Alexandra Cameron was consulted and uncertainties were
discussed to ensure a consistent framework for assessing websites. The results of the qualitative
analysis of the site quality were grouped according to WHO region to see if there are any regional
trends.
Criteria for assessing site quality for undertaking international price comparisons
Table 1 : Overview of scoring system site quality
Site quality 0 1 2 User-friendliness Unclear layout and
undesired advertisements Unclear layout or undesired advertisements
Clear layout and no undesired advertisements
Update: site & price information
No information on update or last update longer than 1 year ago
Last update between 1 and 12 months ago
Last update within 1 month
Site map / Search No site map, nor general search engine
Site map or general search engine
Site map and general search engine
Basis for access Access fee to be paid No access fee, but registration required
No access fee, no registration required
Accessibility of information
Price information available after more than 10 clicks, no search ability within price information, no download/print version
Price information available after 5 to 10 clicks, no search ability within price information, download or print version
Price information available with no more than 5 clicks, search ability within price information, download and print version
Speed to search page
Download time at 56 K per second is more than 60 seconds
Download time at 56 K per second is 30 to 60 seconds
Download time at 56 K per seconds is less than 30 seconds
Author information No disclosure of source reputation nor up to date contact information for price author
Disclosure of source reputation or up to date contact information for price author
Disclosure of source reputation and up to date contact information for price
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author Links No price reporting links,
no other useful links or expired links
Some useful links, no price reporting links and/or some expired links
Price reporting links, other useful links and no expired links
The quality of a website can not be interchanged with the quality of the price information reported.
As such, in addition to the criteria described in Table 1, a separate set of criteria was needed to
evaluate the quality of the price data being reported. Information describing the type of price data
being reported is an important indicator of quality as it enables users to clearly understand the
prices they are accessing. For example, price components such as distribution margins, sales
taxes or patient co-payments are an important factor in achieving reliable price comparisons, but
are not always included in the price published. Therefore, additional information on whether or not
these components are included is necessary. (13) Good quality price information should show
additional price information to enhance price comparisons. To address this issue a checklist for
assessing the quality of the price information has been designed for each price type (e.g. ex-
factory, procurement) (Table 2 to 6).
Criteria for assessing price information for undertaking international price comparisons
Do the prices reported include the following information? Yes / No
Table 2 : Ex-factory / manufacturer prices
Ex-factory price YES NO SPECIFICATIONS
Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size INCO term (CIF, FOB, DDP; exports only)
Exchange rate (if not national currency) Date of price information Price type (actual, list, indicative, discount or average prices)
Quality (e.g. registration number) Pharmacopoeial specifications (USP, BP, EP, other)
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Table 3: Procurement prices
Procurement price YES NO SPECIFICATIONS
Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size INCO term (CIF, FOB, DDP; exports only)
Supplier (e.g. manufacturer, wholesaler, local agent) Volume purchased Purchase terms (e.g. national or international prequalification, open or closed tender, direct procurement from non-profit supplier; 1-,2- or 3-year contract)
Payment terms / timelines (e.g. emergency order) Date of price information Date of procurement award (procurement cycle) Exchange rate at time of award Quality (e.g. registration number) Pharmacopoeial specifications (USP, BP, EP, other)
Taxes & duties & other charges
Table 4 : Wholesale prices Wholesaler price YES NO SPECIFICATIONS
Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size Volume (minimum purchase) Exchange rate (if not national currency) Date of price information Price type (actual, list, indicative, discount or average prices)
Taxes & duties & other charges
Table 5 : Reimbursement prices
Reimbursement price YES NO SPECIFICATIONS
Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size Exchange rate (if not national currency) Date of price information Taxes & duties & other charges Price incl. co-payments Price incl. dispensing fee
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 21
Table 6 : Retail / Patient prices Retail / Patient price YES NO SPECIFICATIONS
Country: Website: INN name & dosage form & strength Brand name & manufacturer Exchange rate (if not national currency) Date of price information Taxes & duties & other charges Price incl. co-payments Price incl. dispensing fee
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 22
IV - 4. Quantitative analysis of price information
A quantitative analysis was conducted to assess the feasibility of comparing web-based medicine
pricing information from different sources. All price data used was publicly available on the
national websites of 50 sources (Annex II). The analysis was performed on the price data of 7 of
the 14 medicines collected globally in WHO/HAI surveys. These 7 medicines are: amitriptyline
25mg cap/tab, atenolol 50mg cap/tab, ciprofloxacin 500mg cap/tab, glibenclamide 5mg cap/tab,
omeprazole 20mg cap/tab, salbutamol 100mcg/dose inhaler and simvastatin 20mg cap/tab.
These medicines were chosen to reflect a range of therapeutic categories and a high availability
of price data was expected.
Five different price types were collected from the national websites: ex-factory/manufacturer,
procurement, wholesale, reimbursement and retail/patient. Several data limitations could lead to
comparability issues, and as such results provide only a general indication of price variations
across countries. To improve the comparability of price across different sources, all prices were
adjusted for 5 criteria:
1. Exchange rate specific for date of price information (if not in US$);
Prices found on the websites have been changed into US dollars (US$) using an
exchange rate specific for the date of the price information provided. If the date of price
information is unknown, the average exchange rate for 2008 was used to improve the
comparability with the MSH 2008 prices.
2. INCO term (CIF, FOB, DDP);
Ex-factory and procurement prices were to be adjusted to a single INCO term to improve
comparability between sources, however none of the sources specified its INCO term
which made it impossible to adjust for this criterion.
3. Reimbursement price calculated based on retail/patient prices;
The retail/patient prices reported on some of the websites, also provided information on
the amount that would be reimbursed (percentage). When this was the case, the
reimbursed price was calculated based on the retail/patient price (100%).
4. Dispensing fee excluded for reimbursement and retail/patient prices;
Where reimbursement or retail/patient prices included a dispensing fee and the amount of
this fee was specified, it was deducted from the price.
5. VAT/GST excluded for reimbursement and retail/patient prices;
Where reimbursement or retail/patient prices included a Value Added Tax (VAT) / Goods
and Services Tax (GST) it was deducted from the price according to the percentage
mentioned on the price source website or a country specific governmental website.
Price adjustments were made whenever sufficient information was available to do so; however in
some cases websites did not include the necessary data to perform the adjustments.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 23
To compare prices across different sources, the MSH (Management Sciences for Health)
reference prices were used to calculate a ratio, that is, the ratio of the national price to the MSH
price. The reference prices were obtained from the most recent (2008) MSH International Drug
Price Indicator Guide, which reports price data from 2007. The mean and median value of the
prices and MSH price ratio were calculated if more than 3 prices were available for the price type.
The median shows the value around which most of the prices are centered; the mean provides
information on the average value which is usually slightly higher than the median due to outliers
in the dataset. The ratio of the highest price to the lowest price (high/low (H/L) ratio) has also
been calculated. It is an important parameter, as it shows the variation in prices across sources,
though comparability issues must be taken into account (e.g. some prices include VAT while
others do not).
For all 7 medicines the originator brand products have been excluded from the price comparison;
however branded generics were included when INN (unbranded) generics were unavailable.
Originator brand products were excluded because the calculated MSH price ratios would not be
comparable to generic products. Furthermore, the differences between countries would be too
great because some countries only published the prices of INN generics and would thus have
much lower prices and MSH price ratios than the countries with originator brand products.
In addition to the quantitative analysis of the 7 medicines described above, two branded
medicines were compared to their generic therapeutic equivalents to emphasize the importance
of generic substitution. The prices of the branded medicine Lipitor (Pfizer) 20mg cap/tab were
compared to the INN generic simvastatin 20mg cap/tab; while Nexium (Astra Zeneca) 20mg was
compared to the INN generic omeprazole 20mg cap/tab. Because for both medicines a MSH
reference price was not available, the local prices of simvastatin or omeprazole respectively, were
used as a reference.
Instead of a MSH price ratio, this time a country price ratio was calculated, that is, the price of
Lipitor or Nexium in country A divided by the price of simvastatin or omeprazole in country A.
All branded atorvastatin products manufactured by Pfizer were included (e.g. Lipitor, Sortis, Tahor
and Torvast) and the same method was used for esomeprazole products manufactured by Astra
Zeneca (e.g. Nexium, Nexiam and Inexium).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 24
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 25
V - RESULTS
V - 1. Qualitative Analysis As a first step comprehensive lists of national and international websites reporting medicine price
information were drafted after identification of the websites through primarily web based
searches.
Many publicly available websites reporting medicine prices from both national and international
sources were identified (Annex II to Annex IIIb). In total 50 national price source websites were
found, representing 36 countries worldwide (for Canada, France, India, Norway, Portugal, South
Africa, Spain, the UK and the USA two or more medicine pricing websites were found). In
addition, 21 international price source websites were collected. Out of these international
websites, 14 websites were identified as international price guides and the remaining 7 websites
were listed as international (non-profit) supplier price lists. The source of the website, general
information and the type of price information they contained, were determined for each of the
websites. A comparative qualitative analysis was then performed by scoring the identified national
websites on the designed general and price-specific criteria. A complete overview of both the
general and price-specific quality tables can be found in Annex IV to XIII (results per WHO region
and per organization).
Below, the national websites are grouped according to WHO region (AFRO, AMRO, EMRO,
EURO, SEARO and WPRO), section V - 1.1. All countries were also analysed according to their
World Bank Income Group. A textual description of price quality available per WHO region is
listed after the site quality comparison of the region.
The international websites are grouped in order to keep a clear overview when comparing all
results to each other (section V - 1.2). The Global Fund to fight AIDS, Tuberculosis and Malaria
(GF) was grouped with the AIDS Medicines and Diagnostic Services (AMDS) because both report
prices of antiretrovirals (ARVs), anti-tuberculosis and anti-malaria medicines. The Clinton
Foundation (CF) and Médecins Sans Frontières (MSF) were linked for similar reasons, both
websites report ARV medicines. The websites of the Common European Drug Database (CEDD),
Management Sciences for Health (MSH) and the Österreichises Bundesinstitut für
Gesundheitswesen (ÖBIG) were grouped because all three sources are important multi country
price information websites. Lastly, the pricing websites of the World Health Organization (WHO)
regions (e.g. AFRO and PAHO) and departments (e.g. Malaria Price Information Services) were
grouped with the pricing websites of the International Trade Centre (ITC - MNS report), Health
Action International (HAI - Global Database) and the United Nations Children's Fund (UNICEF).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 26
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 27
V - 1.1 NATIONAL WEBSITES
African Regional Office (AFRO)
Table 7: Summary of qualitative analysis of websites reporting medicine prices in AFRO countries
COUNTRY World
Bank
income
group
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
South
Africa
MP
MoH
UMI
2
0
1
2
1
2
2
1
South
Africa
DMP
MoH
UMI
2
1
1
2
1
2
2
1
South
Africa
TAC
TAC
UMI
2
1
1
2
1 /
1.3
2
2
1
MP = Manufacturer Pricelists; DMP = Database Medicine Prices; TAC = Treatment Action Campaign; MoH = Ministry of
Health; UMI = upper-middle-income
User-friendliness
All South African websites receive the highest score on this criterion.
The homepage of the Ministry of Health website (MP and DMP link) lacks clarity as it contains
several different formats and colors, but this page changes into a screen with a clear layout after
one click. The price information is presented in a clear layout and therefore the website still gets
the highest score. The entire contents of all three websites are available in English.
Update: site & price information
The date that the general site was last updated was not found on any of the three websites.
However, all websites clearly list the last update of the price information. The TAC website had
updated its price information less than 1 month ago, as had the database with medicine prices on
the website of the Ministry of Health (MoH). The manufacturer pricelists on the MoH website were
last updated over one year ago.
Site map / search
The TAC website shows a clear overview of the site in a useful site map, while the MoH website
does not have a site map. But the MoH website has, in contrast to the TAC site, a useful search
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 28
engine. It enables searches by INN name, and the search results link to documents with
background information and prices for the selected medicine.
Basis for access
Both websites provide medicine price information free of charge and without the need for
registration.
Accessibility of information
Starting at the homepage of each website, price information can be accessed in less than 10
mouse clicks. The websites therefore score well on this indicator of information accessibility.
None of the websites provide a search option within their price information. On the MoH website
prices are listed by manufacturer name and not by INN name. It is therefore difficult to obtain
information on similar medicines and to compare the prices of the same medicine across different
manufacturers. On the TAC website medicines are listed in an A-Z index by INN name, but
searches are still not possible.
With respect to the formats available for price information, the TAC website provides private
sector single exit prices in an online version, a print version and as a download. However, the
public sector price list is only available online and as a print version. The price lists on the MoH
website can be downloaded, but a direct print version is not available.
Speed to search page
The download time at 56K per second was less than 30 seconds for all three price links.
Information is therefore obtainable in a reasonable timeframe.
Author information
The MoH website provides information on the background, mission and view of the Ministry.
Contact information for all Ministry employees is available online and in addition, a document
containing a 'Call for submissions on the schedule of medicine prices' is posted in the same
window as the prices and contains contact information of the responsible authors.
The TAC website also discloses its source and lists the contact information of all employees,
including that of the authors responsible for price documentation.
Links
None of the websites include links to other websites reporting medicine prices. The TAC website
provides links to some relevant national websites; the MoH website provides links to useful
national and provincial health websites, as well as international and HIV/AIDS-related websites.
Available price information
Ex-factory / manufacturer price
The website of the Ministry of Health shows this price information for several manufacturers. All
prices are listed by both brand name and INN name and all are shown in the national currency
South African Rand. The prices can be accessed through manufacturer lists (reference price list)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 29
or through the general medicine database (actual prices). The reference price list is valid in a
given timeframe; the actual prices are updated at the beginning of each month.
Procurement price
The TAC website publishes procurement prices in the national currency South African Rand. All
prices are listed by both INN name and brand name and for every medicine the supplier, package
specifications and volume purchased are known. All tender prices represent a 24 month contract
with the listed supplier; price details such as logistics fee and VAT (14%) are shown in specified
amounts, all published procurement prices are exclusive of this fee and VAT.
Wholesale price
In the general medicine database (actual prices) on the Ministry of Health website, wholesale
prices are listed next to the manufacturer prices. All prices are listed by both brand name and INN
name and all are shown in the national currency South African Rand. The database shows the
Single Exit Price (SEP), which is the wholesale price, is calculated by adding the logistics fee and
VAT (14%) to the ex-factory price. Both logistics fee and VAT are shown in specified amounts.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 30
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 31
The Americas Regional Office (AMRO)
Table 8: Summary of qualitative analysis of websites reporting medicine prices in AMRO countries
COUNTRY World
Bank
Income
Group
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
Brazil MoH
UMI 2 0 1 2 1.3 2 0 0
Canada PMPRB MoH cooperation
HI 2 1 1 2 1.3 1 2 0
Canada OPDP MoH
HI 2 1.5 1 2 1.7 2 2 1
USA PBM DVA
HI 2 2 2 2 1 2 2 0
USA CMS DHH
HI 2 1.5 1 2 1 2 2 0
USA CHFS Kentucky CHFS
HI 2 2 2 2 1 1 2 1
USA CDC Vaccine DHH
HI 2 2 2 2 0.7 2 1 1
MoH = Ministry of Health; PMPRB = Patented Medicine Prices Review Board; OPDP = Ontario Public Drug Programs; PBM = Pharmacy Benefits Management Services; DVA = Department of Veterans Affairs; CMS = Centers for Medicare & Medicaid Services; DHH = Department of Health & Human Services; CHFS = Cabinet for Health and Family Services; CDC = Centers for Disease Control and Prevention; UMI = Upper Middle Income; HI = High Income; User-friendliness
For AMRO 7 websites were reviewed, representing Brazil (1), Canada (2) and the United States
of America (4). All these websites are given a high score on user-friendliness.
The Brazilian website is available in Spanish, Portuguese and English; both Canadian websites
are available in English and French. The entire contents of all three USA websites are available in
English; the CDC website is also partly available in Spanish (only CDC homepage, not price list).
Furthermore, the website front can also change to the following languages (menu options and a
selection of information in this language, but not all menu options available): Chinese, French,
Russian, Portuguese, German, Italian, Vietnamese, Haitian Creole, Korean, Tagalog (Filipino).
Update: site & price
The USA websites of PBM, CHFS and CDC are awarded with the highest score on this criterion.
Both the website in general and the price information are updated at least once every month.
The 1,5 score for Canada OPDP and USA CMS is for the same reason, the last update of price
information is between 1 month and 1 year ago on both websites. The Canadian PMPRB website
regularly updates its website in general, but price information of patented medicines is collected
during the introductory period just after receiving patent, therefore different price data are listed.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 32
Since most data is from several years ago, the criterion update is rewarded with a combined
score of 1. For Brazil no information on either updates of the site in general or updates of prices
are listed.
Site map / search
Out of the 7 websites, 3 USA websites (PBM, CHFS and CDC Vaccine) contain both a site map
and a useful search engine. On the USA CDC Vaccine website a site map is available on the
website and an A-Z index with all contents. Searches on INN name are not applicable in this case
because only vaccine names are listed, a search on vaccine name is possible and search results
include background articles and a direct link to the price database. On the other 2 USA websites
searches on INN name are possible, they do however not link directly to price information.
The remaining 4 websites are all rewarded with score 1 for the same reason, on none of these
websites a site map can be found, but they all do have a useful search engine. The search
engine on the Brazilian website provides searches on item type (medicines, hospital medical
equipment, medicinal gases, nutrition - food, health services); searches by INN name are not
possible, but the search results are listed as an A-Z index on INN name.
The site map button of the Canadian OPDB websites links to another site, but there's no sitemap
on this homepage and no additional information on Ontario Drug Benefit (ODB) program. The
website does enable searches by INN name and by brand name.
Basis for access
All websites provide medicine price information free of charge and without the need for
registration.
Accessibility of information
The price information on 6 websites is available in less than 10 mouse clicks.
The Brazilian website and both Canadian websites provide a search option within the price
information. The search results on the Brazilian website can be listed as an A-Z index by INN
name, classification, institution or as a report with minimum and maximum prices. On the Canada
PMRB website an A-Z index of patented medicines can be searched through searches by INN
name on top of the page in the search box. The Canadian OPDP website contains an e-
Formulary in which can be searched by INN name, brand name or Canadian medicine code.
On none of the website it is possible to both download and print the price information. Both
Canadian websites and 3 USA websites (PBM, CMS and CHFS) provide a download option, but
a direct print of the price information is not possible.
Speed to search page
The download time at 56K per second was less than 60 seconds for all websites. For Brazil,
Canada OPDB, USA PBM, USA CMS and USA CDC Vaccine this download time was even less
than 30 seconds.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 33
Author information
Both Canadian websites and 3 USA websites (PBM, CMS and CHFS) give full disclosure of the
source/author of the website in general and list specific contact information for the price
information author(s). On the websites of USA CDC also full disclosure of the source/author of
the website in general is given, but no specific contact information for the price information
author(s) is listed.
Links
None of the websites show links to other price reporting websites. The websites of Canada
OPDB, USA CHFS and USA CDC Vaccine do however display some useful national and
international links to health related or governmental websites.
Available price information
Ex-factory / manufacturer price
The Canadian PMPRB website is the only one in the AMRO region which publishes this price.
Prices are initially listed on brand name, since this website shows price information of patented
drugs in Canada. All prices are in Canada's local currency Canadian Dollars (CA$). Both actual
(buyer/supplier source) and indicative prices (estimated price) are listed for each medicine; all
prices are collected during the introductory period just after receiving patent, therefore different
price data are listed.
Procurement price
Brazil and two USA websites (PBM and CDC Vaccine) in the AMRO region publish this price. On
all three websites prices are listed by both brand name and INN name and all are shown in the
country's local currency (Brazilian Real (BRL) and US Dollars (US$), respectively).
Supplier, package specifications, volume purchased and the date of price information (individual
date per medicine for Brazil) are listed, other characteristics, such as INCO term and taxes, are
not specified. The prices on both USA websites are tender prices and provide information on the
contracts with suppliers and buyers.
Reimbursement price
The Canadian OPDB website and the two remaining USA websites (CMS and CHFS) publish
reimbursement prices. All prices are listed by both brand name and INN name (indexed on INN
name) and all are shown in the country's local currency (Canadian Dollars (CA$) and US Dollars
(US$), respectively). On the website of Canada the drug benefit price and the amount reimbursed
are listed, the difference between these numbers can be seen as co-payment. Details on taxes
and dispensing fee are not clearly listed per medicines. For the USA websites specifications on
the inclusion of taxes, co-payment and dispensing fee are unknown.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 34
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 35
Eastern Mediterranean Regional Office (EMRO) Table 9: Summary of qualitative analysis of websites reporting medicine prices in EMRO countries
COUNTRY World
Bank
income
group
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
Bahrain
MoH
HI 2 0.5 1 2 1.3 1 2 1
Iran
MoH
LMI 2 0.5 1 2 1.3 1 1 1
Jordan
FDA
LMI 2 0 0 1 1.3 2 0 0
Lebanon
MoH
UMI 2 1.5 2 1 2 1 2 1
Morocco
ANAM
LMI 2 1 2 2 2 1 1 1
Oman
MoH
UMI 2 1 1 2 1.7 2 2 0
Sudan
NMPB
LI 2 0.5 0 2 1.3 2 1 0
Tunisia
MoH
LMI 2 1 0 2 1.7 2 2 1
MoH = Ministry of Health; FDA = Food and Drug Administration; ANAM = National Agency of Health Insurance; NMPB = National Medicines & Poisons Board;
User-friendliness
All countries are rewarded with a high score on this criterion. All websites display a clear layout;
as an example, the Lebanon MoH website has all menu options in a panel on the left, with
subcategories for each menu option that open to the right of the menu panel. As a result, options
are clearly and logically presented and navigation through the website is simple and
straightforward. Another example is the Sudan pricing link, whose start screen includes a search
box which allows users to access price information without navigating through the website. It also
includes general information that clearly describes the contents of the database (only in Arabic).
Update: site & price information
Of the websites from the EMRO region, Lebanon has the highest score on this criterion. Its
website is updated daily; however the last update of the price information was more than one
month ago, resulting in a combined score of 1.5 for this criterion. The Iran, Jordan, Morocco,
Oman and Sudan websites did not display the last update of the general website. The websites of
Iran and Morocco display the date of creation/copyright of the website, but this does not give any
insight on the last update. With the exception of Bahrain and Tunisia, all websites provide the
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 36
date and/or last update of the price information. The price data from Iran, Lebanon, Morocco and
Oman had all been last updated in the first quarter of this year (2010).
Site map / search
Morocco received the top score for this criterion; its website has a clear sitemap which shows
users how to navigate through various menu options. In addition it includes a search box for the
general website. With the exception of Lebanon and Morocco, none of the websites have both a
site map and a general search engine. The Oman site contains a search box for the general
website, but unfortunately the search engine was not operating at the time of access. Websites
from Bahrain and Iran do not have a site map, but do contain a search box for the general
website.
Basis for access
With the exception of Jordan, all websites provide medicine price information free of charge and
without the need for registration. The basis for access varied across sources. The Jordan website
is accessible free of charge, however registration is required to access the price information. The
website provides a guest account so that anyone can access price information; the registration
feature is used to keep users up to date on changes and additional information.
Lebanon's website does not require a fee or registration to access the medicine price information;
however registration is necessary to access additional information such as exchange rates used
for imported pharmaceuticals. Moreover, after registration you need to request permission to see
this additional information on the price database.
Accessibility of information
Of the websites from the EMRO region, price information is available in less than 10 mouse
clicks. The websites therefore score well on this indicator of information accessibility.
The Bahrain website is an example of a site where pricing information is easily accessible; it
includes a search function for price data. The price database consists of an A-Z index by brand
name and a search box; however searches are only possible by brand name and not by INN
name. The price information on the websites from Iran, Jordan, Lebanon, Tunisia, Sudan, Oman
and Morocco all allow prices to be searched by INN name, and some also allow searching by
trade/brand name, ATC code, therapeutic class, price date, manufacturer, country of origin, and
sales agent. If you click on one of the search results on the Morocco website, you are linked to a
table with all possible hits for this medicine (all brands, generic and originator). The prices on the
Lebanese website can be searched by brand name (originator) and INN name; however search
results are not combined as they are on the Moroccan site. For example, the search term
amoxicillin only provides results for generic products, while search term amoxil only provides
results for the originator brand. A bonus feature on the Morocco website is a drop-down tab below
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 37
the searches box that shows examples of medicine names that match the search term. This is a
useful tool as it addresses the issues of typographical errors and name differences between
countries.
Of the EMRO websites, only Lebanon and Morocco have both a download and a print version of
the prices available. Both websites include a 'print screen' feature to their searches box, however
for Lebanon some important details (strength, pack size, dosage form, pharmacist margin) are
not printed when using this feature. Price information from Iran, Tunisia and Oman can be printed
per individual search item, while Sudan does not provide a print option. None of the websites
allow the complete database to be printed at once.
Speed to search page
The download time at 56K per second was less than 60 seconds for all websites. Information is
therefore obtainable in a reasonable timeframe. For Jordan, Oman, Sudan and Tunisia the
download time was less than 30 seconds.
Author information
Bahrain, Lebanon, Oman and Tunisia give full disclosure of the source/author of the general
website and list specific contact information for those responsible for the price information. On the
websites from Iran, Morocco and Sudan, full disclosure of the source/author of the general
website is also provided, but no specific contact information for the price information author(s) is
listed.
Links
None of the websites include links to other price reporting websites. The websites from Bahrain,
Iran, Lebanon, Morocco and Tunisia do, however, display some useful national and international
links to health-related and/or government websites.
Available price information
Procurement price
Sudan is the only country in EMRO that publishes the procurement price. The Sudan Index 2009
lists entry prices into the country for imported medicines and retail prices to the public for
medicines produced by national pharmaceutical manufacturers (both are procurement prices).
In the Sudan Index 2009, INN name, brand name, manufacturer, packaging specifications,
supplier and date of price information are all specified for each medicine. Prices are listed in
different currencies (e.g. US$, Euro (€), Iranian Rial), including different currencies within
countries, making it difficult to compare between companies and countries of origin.
Reimbursement price
Morocco is the only country in EMRO that publishes the reimbursement price. All prices are
published in the national currency (Moroccan Dirham). It is not specified if the reimbursement
prices listed include a dispensing fee.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 38
Retail/Patient price
Bahrain, Iran, Jordan, Lebanon, Morocco, Oman and Tunisia all publish retail/patient prices on
their websites. All prices are again listed in national currencies (Bahraini Dinar, Iranian Rial,
Jordanian Dinar, Lebanese Pound, Moroccan Dirham, Omani Rial and Tunisian Dinar,
respectively). For Bahrain, Jordan, Lebanon and Tunisia the date of the price information is not
provided. The Lebanon retail prices include the dispensing fee, and the Moroccan website
includes information on patient co-payments, however for other countries no specifications on co-
payment and dispensing fee are provided. On the Iranian website for each individual medicine,
the date of the price information is provided.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 39
European Regional Office (EURO)
Table 10: Summary of qualitative analysis of websites reporting medicine prices in EURO countries2
COUNTRY World
Bank
Income
Category
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
Austria CEDD
HI 2 0.5 2 2 1.3 2 0 2
Belgium MoS
HI 1 2 2 2 1.7 2 2 1
Czech Republic CEDD
HI 2 0 2 2 1.3 2 0 2
Denmark DMA
HI 2 2 2 2 1.7 1 1 1
Finland CEDD
HI 2 0.5 2 2 1.3 2 0 2
France Codage NHI
HI 2 2 1 2 1.7 2 0 0
France CEPS MoH
HI 2 0 1 2 1.3 1 1 0
Germany MoH
HI 2 2 2 2 1 2 2 1
Hungary CEDD
UMI 2 0.5 2 2 1.3 2 0 2
Ireland CEDD
HI 2 0.5 2 2 1.3 2 0 2
Italy MoH
HI 2 0 2 2 1.3 2 1 1
Latvia CEDD
UMI 2 0.5 2 2 1.3 2 0 2
Lithuania CEDD
UMI 2 0 2 2 1.3 2 0 2
Netherlands CHI
HI 2 0 1 2 1.3 2 1 0
Norway CEDD
HI 2 0.5 2 2 1.3 2 0 2
Norway NMA
HI 2 1 2 2 1 1 2 0
Poland CEDD
UMI 2 0 2 2 1.3 2 0 2
Portugal originator MoH
HI 2 1 2 2 1.7 2 2 1
Portugal HI 2 2 2 2 1.3 2 2 1
2 # After the closing date of the qualitative analysis additional websites were identified for the Czech Republic and the United
Kingdom; for Belgium a separate database on the previously included website was identified. These three websites/databases are listed
and analyzed individually in the qualitative analysis annex but not included in the WHO regional analysis, as they became available after the closing date of this comparative analysis.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 40
generic MoH Slovakia CEDD
UMI 2 0 2 2 1.3 2 0 2
Slovenia CEDD
HI 2 0 2 2 1.3 2 0 2
Spain AEMPS MoH
HI 2 0.5 2 2 1.7 1 2 1
Spain Vademecum UBM
HI 1 1 2 2 2 1 2 1
Sweden MoH
HI 2 1 2 2 2 2 1 1
United Kingdom Scottish Drug Tariff SG
HI 2 2 2 2 1 1 2 2
United Kingdom eMIT MoH
HI 2 1 1 2 1.7 0 2 0
United Kingdom Drug Tariff for England and Wales MoH
HI 2 1 1 2 1.7 2 2 0
United Kingdom BNF
HI 2 0.5 1 0/1 ? 1 2 0
CEDD = Common European Drug Database; MoS = Ministry of Social Affairs; DMA = Danish Medicines Agency; NHI = National Health Insurance; CEPS = Comité Economique des Produits de Santé; MoH = Ministry of Health; CHI = College for Health Insurances; NMA = Norwegian Medicines Agency; AEMPS = Agencia Española de Medicamentos y Productos Sanitarios; UBM = United Business Media Medica Spain; SG = Scottish Government; BNF = British National Formulary; HI = High Income; UMI = Upper Middle Income;
User-friendliness
For Europe 28 websites were reviewed, representing 21 countries. Out of all these websites, 26
are rewarded with a high score on user-friendliness. All these websites display a clear layout, as
an example, the Dutch, Danish and French CEPS website are theme sites specific for medicine
prices. The homepage screen is a search box and search results are displayed in a table with
clear layout. The websites of Italy, Norway NMA and both Portuguese websites are divided in
different sections dependent on the user of the website. Norway shows a section with general
information, a consumer part, a health professional part, a pharmacy and wholesaler part, and an
industries part. Italy and Portugal divide their websites into sections for patients and consumers,
for health professionals, for pharmaceutical companies (pharmacies and suppliers), and for the
industry (Portugal) or a pressroom (Italy). All websites are available in their national languages
(French and Dutch for Belgium); the entire contents of the Danish and German website are also
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 41
available in English. The CEDD website is an exception because it lists the prices of several
countries (Austria, Czech Republic, Finland, Hungary, Ireland, Latvia, Lithuania, Norway, Poland,
Slovakia, Slovenia). The website in general is in English, all product names and dosage form are
listed in the national language; all other characteristics are in English.
Update: site & price
The websites of Belgium, Denmark, France Codage, Germany, Portugal generic and United
Kingdom Scottish Drug Tariff were awarded with the highest score on this criterion. On the
Danish website prices are updated every fortnight and reimbursement figures are updated daily.
For both the website in general and for the price information they clearly displayed the last update
and all these updates were carried out less than one month ago. For most websites it was
unknown when the website in general was last updated, resulting in a score of 1 or less.
Site map / search
22 out of the 28 websites contain both a site map and a useful search engine. The CEDD website
provides the option to search by country or by ATC code, the site map can also be organized by
country or ATC code. Most websites can be searched by INN name, but both French websites
even provide advanced search option in which can be searched on more criteria (e.g. brand
name, therapeutic indication, manufacturer). An additional feature on Italy's website is a pull-
down tab with medicine news (background information), specific for every INN name.
The website of Sweden provides a search on INN name and search results link to additional
information in background documents, but also a specific link displaying how many hits are found
in the pricing database (direct access link) is shown.
The remaining 6 websites are all rewarded with score 1 for the same reason, on none of these
websites a site map can be found, but they all do have a useful search engine.
Basis for access
All websites provide medicine price information free of charge and without the need for
registration. On the website of Portugal you do need to register to download the database.
The only exception is the website of the British National Formulary, this website is free to access
for residents of the United Kingdom and some developing countries (list on website), but all other
users need to register in order to get access to the price information.
Accessibility of information
The price information is available on all websites in less than 10 mouse clicks.
A total of 24 websites provide a search option within the price information, mostly on INN name. A
good feature on the CEDD website is the possibility to compare prices between different
countries based on their ATC code and the date of price information. Italy, Portugal and Spain
enable searches within prices on more than just INN names (e.g. product name, manufacturer,
ATC code, retail price and therapeutic group).
Only the website of Sweden and the Spain Vademecum website provide both a download and a
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 42
print version of the prices database. The websites of Belgium and Denmark and the UK Drug
Tariff England and Wales website provide a direct print option, but no download version of the
prices. For France Codage, Germany, Norway NMA, Portugal originator, Spain AEMPS, UK
Scottish Drug Tariff and UK eMIT this is the other way around, they have a download version
available, but no direct print option. The remaining 15 websites provide neither a print option nor
a download version.
Speed to search page
The download time at 56K per second was less than 60 seconds for 27 websites. For 20 out of
these 27 websites this download time was even less than 30 seconds.
Author information
Belgium, Germany, Norway NMA, both Portuguese, both Spanish and all 4 UK websites give full
disclosure of the source/author of the website in general and list specific contact information for
the price information author(s). On the websites of Denmark, France CEPS, Italy, the Netherlands
and Sweden also full disclosure of the source/author of the website in general is given, but no
specific contact information for the price information author(s) is listed. The remaining 12
websites do not disclose the source/author of the websites or specific contact information for the
price author(s).
Links
The CEDD website (representing Austria, Czech Republic, Finland, Hungary, Ireland, Latvia,
Lithuania, Norway, Poland, Slovakia and Slovenia) and the website of UK Scottish Drug Tariff,
link to other price reporting websites. The websites of Belgium, Denmark, Germany, Italy,
Portugal (both) and Spain (both) don't list other price reporting websites, but do however display
some useful national and international links to health related or governmental websites.
Available price information
On all 28 websites medicines are listed on INN name and all prices are shown in the national
currency. All prices on the CEDD website are shown in Euro's, regardless if this is the national
currency of the country published.
Ex-factory/manufacturer price
Austria, the Czech Republic, France Codage, Hungary, Lithuania, Slovakia and Spain
Vademecum publish ex-factory/manufacturer prices. All prices are presented in more or less the
same layout, none of the countries is clear on the INCO term, price type (e.g. actual, list,
discount), quality or pharmacopoeial specifications. All other characteristics for this price type are
clearly listed on each of the websites.
Procurement price
The websites of Denmark, Sweden and UK eMIT list procurement prices. Next to INN name,
brand name, pack size and date of price information, Denmark and Sweden do not list any
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 43
additional characteristics for these prices. The website of UK eMIT however gives insight on INN
name, pack size, volume purchased, date of price information and information on taxes & duties
& other charges.
Wholesale price
Austria, Finland, Hungary, Ireland, Latvia, Lithuania, Norway and Slovenia publish wholesale
prices on the CEDD website. Details on price type and taxes & duties & other charges are
unknown. Sweden and the Norwegian NMA website present wholesale prices as well, on these
websites information on taxes & duties & other charges is unknown.
Reimbursement Price
The amount reimbursed is published on the websites of Belgium, Denmark, France (both),
Germany, the Netherlands, Norway NMA, Portugal (both), UK Scottish Drug Tariff and UK Drug
Tariff for Wales and England. Denmark and the Netherlands have not included the dispensing fee
in this price, but for the other countries it's unclear if this fee is included or not. For Belgium and
both UK websites it is also unknown if VAT is included in the price.
Retail/Patient Price
A number of 18 European websites publish retail/patient prices, including 9 countries on the
CEDD website (Slovenia and Ireland don't list this price). For this price type it is unknown in most
cases whether or not the dispensing fee and co-payments are included. Other characteristics are
all clearly listed within the price overview or in texts supporting the price information.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 44
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 45
South East Asia Regional Office (SEARO)
Table 11: Summary of qualitative analysis of websites reporting medicine prices in SEARO countries
COUNTRY World
Bank
income
group
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
India
NPPA
MoCF
LI 2 0 2 2 1 2 1 1
India
TNMSC
MoH
LI 2 1 0 2 1 1 1 0
NPPA = National Pharmaceutical Pricing Authority; TNMSC = Tamil Nadu Medical Services Corporation Ltd. MoCF = Ministry of Chemicals and Fertilizers; MoH = Ministry of Health & Family Welfare; LI = low-income
User-friendliness
Both Indian websites are rewarded with the highest score on this criterion. Each displays a clear
layout, for example, it is easy to see where additional information on medicine prices can be
found. The entire contents of both websites are available in English and the NPPA website is also
available in Hindi.
Update: site & price information
There is no information available on the last update of either the NPPA or TNMSC website.
However, the TNMSC website does display the date the price data was last updated and this was
done less than one month ago; the site was therefore given a combined score of 1 for "update".
Site map / search
The NPPA website includes both a site map and a useful search engine, resulting in a maximum
score of 2. Searches can be performed by INN name and moreover, the search results link to
most recent documents with price information.
Basis for access
Both websites provide medicine price information free of charge and without the need for
registration.
Accessibility of information
The price information is available on both websites in less than 10 mouse clicks. The websites
therefore score well on this indicator of information accessibility.
The NPPA website lists all price (?) information in an A-Z index, however there is no additional
option to search within price data. The TNMSC site does not include a search option for price
data. Prices are only available in a downloadable document and within this document they are
listed by product number (random alphabetical order).
On both websites price information is available in a downloadable format; however it is not
possible to print the prices directly from the websites.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 46
Taking into account all criteria included in "accessibility of information", both websites are
rewarded with an average score of 1.
Speed to search page
The download time at 56K per second was less than 60 seconds for both websites. Information is
therefore obtainable in a reasonable timeframe. For the NPPA website the download time was
even less than 30 seconds.
Author information
The NPPA website lists background information on the National Pharmaceutical Pricing Authority
(NPPA) and their Drug Pricing Control Order (DPCO), but no specific contact information for
those responsible for the price data. The TNMSC website lists background information on the
Tamil Nadu Medical Services Corporation (TNMSC), both generally and for their procurement
services, but no specific contact information is listed with respect to price data.
Links
Neither website includes links to other price reporting websites. The NPPA website does display
some useful links to related departments in the Ministry of Health and to Ministries of Health of
other countries.
Available price information
Both websites list medicines by INN name and show prices in the national currency (Indian
Rupee, INR/Rs).
Procurement price
The TNMSC website contains a document called "Finalized rates and suppliers for the tender for
the supply of Drugs & Medicines to TNMSC for the year 2010-2011". This document lists the
procurement prices of generic products and includes information on packaging specifications,
suppliers and dates of price information.
Retail/Patient Price
The NPPA website includes a document with the prices of bulk medicines as well as an online
database containing the ceiling prices of scheduled formulations. The latter are maximum
retail/patient prices and are exclusive of excise duty and local taxes.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 47
Western Pacific Regional Office (WPRO)
Table 12: Summary of qualitative analysis of websites reporting medicine prices in WPRO countries
COUNTRY World
Bank
Income
Group
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed
to
search
page
Author
info
Links
Australia
MoH
HI 2 2 2 2 1.7 2 2 1
New
Zealand
PMA
HI 2 2 2 2 1.7 2 2 1
MoH = Ministry of Health & Family Welfare; PMA = Pharmaceutical Management Agency; HI = high-income
User-friendliness
Australia and New Zealand are both rewarded with the highest score on this criterion.
On Australia's website three different versions of the Pharmaceutical Benefits Scheme (PBS) can
be accessed: one for consumers, one for health professionals and one for industry. Each is easily
accessible by clicking on the specific version in the menu. New Zealand has a similar layout with
different headings for accessing the Pharmaceutical Schedule for various users: patients &
consumers, health professionals, district health boards and pharmaceutical suppliers.
The entire contents of both websites are available in English; the New Zealand website is also
partly available in Maori.
Update: site & price information
General updates and updates of price information are carried out on a monthly basis on both
country websites. The Australian site displays the PBS Website Update in its general news feed,
and documents are available which provide detailed information on the changes that have been
made. One remark for the website of New Zealand is that the site map has been updated last on
13-11-2008, this doesn't match up to the website in general which is updated every month.
Site map / search
On both websites, site map are available and searches can be performed by INN name. Search
results link directly to price information for the selected medicine (originator brand and generics).
Basis for access
Both websites are accessible free-of-charge and registration is not required to access price
information.
Accessibility of information
The price information is available on each website in less than 10 mouse clicks. The websites
therefore score well on this indicator of information accessibility.
Both websites contain only information specific for the medicine price schedules and therefore the
general search engine can be used to search within the price information.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 48
Information on Australia's PBS can be accessed through simple searches (e.g. INN name, brand
name), advanced searches, or by browsing through various menus (e.g. A-Z medicine listing,
body system, manufacturer name). Information is available as a searchable internet database
that provides a print version of the search results in table format, however it is not possible to
download the database. Information on New Zealand's schedule is also available as a searchable
internet database, but it is also available in a download format (pdf file). The schedule can also be
accessed through simple searches (INN name, brand name) or by browsing by body system. A
direct print of the search results is not possible.
Speed to search page
The download time at 56K per second was less than 30 seconds for both websites. Information is
therefore obtainable in a rapid timeframe.
Author information
Both websites include information on the background, mission and view of the host organization.
In addition, each provides contact information for the author of the price information.
Links
The Australian website provides useful links to Australian health-related websites, but does not
include links to other websites reporting medicine prices. New Zealand also does not include
these links as the site is very New Zealand-specific given their unique funding system. The site
does list a selection of links in a panel on the right hand side of the website, however these are
not clearly labeled and users must follow the links to ascertain the source/nature of the website.
Available price information
All medicine prices are listed in the country's local currency (Australian Dollars (AU$) and New
Zealand Dollars (NZ$), respectively). Both websites update their prices at the beginning of each
month.
Ex-factory/manufacturer price
New Zealand publishes ex-factory/manufacturer prices and includes package specifications.
Prices are reported in units such as price per tablet, capsule, milliliter, etc. However, the website
is not clear on the INCO term, price type (e.g. actual, list, discount), quality or pharmacopoeial
specifications.
Reimbursement price
The Australian website does not provide information on package specifications, so it is
sometimes unclear how many tablets/capsules are contained in a pack. As a result, price data
can be difficult to interpret. For each medicine, the website lists the amount paid by the
government, the maximum paid by the patient, and the reimbursed amount. As such, it is easy to
ascertain whether the reimbursement price includes a co-payment. The website states that
maximum patient prices are inclusive of GST/VAT, however no such specifications are provided
for reimbursed prices. It is mentioned that this price includes all allowable pharmacist fees.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 49
V - 1. 2 PRICE GUIDES
Global Fund to fight AIDS, Tuberculosis and Malaria & AIDS Medicines and
Diagnostic Services
The Global Fund to fight AIDS, Tuberculosis and Malaria (GF) was grouped with the AIDS
Medicines and Diagnostic Services (AMDS) because both do not report all globally available
medicines, but only the medicines important in their own field of work. Meaning that both websites
only report the (procurement) prices of antiretrovirals (ARVs), anti-tuberculosis and anti-malaria
medicines.
Table 13: Summary of qualitative analysis of Global Fund - Price & Quality Reporting Tool (GF - PQR) and
AIDS Medicines and Diagnostics Service - Global Price Reporting Mechanism (AMDS - GPRM) websites
PRICE
GUIDE
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed to
search
page
Author
info
Links
GF - PQR 2 1.5 2 2 2 1 2 2
AMDS -
GPRM
(WHO)
2 1.5 1 2 2 2 1 1
GF = Global Fund to fight AIDS, Tuberculosis and Malaria; PQR = Price & Quality Reporting; AMDS = AIDS Medicines
and Diagnostics Service; GPRM = Global Price Reporting Mechanism; WHO = World Health Organization
User-friendliness
Both the Global Fund PQR Tool (GF - PQR) website and the AIDS Medicines and Diagnostics
Service GPRM (AMDS - GPRM) website were given a high score on this criterion. They display a
clear layout; as an example, the GF website clearly divides its contents into 5 sections: ‘who we
are’, ‘saving lives’, ‘grant portfolio’, ‘applicants/implementers’ and ‘media center’. This facilitates
navigation through the individual pages and allows users to quickly find what they are looking for.
Both websites are available in English. All contents on the GF website in general are also
available in Spanish, French, Chinese, Arabic and Russian. The general WHO website is also
available in these languages, however the AMDS contents are only available in English.
Update: site & price information
Neither website displays the date of last update of the general website. Both list 2010 as their
date of copyright, but this does not give any insight on the last update. However, both websites
specify the date of last update of the medicine price information, and in both cases prices were
last updated less than one month from the date of access.
Site map / search
The GF website contains a site map in which the PQR tool is displayed as an active link, but the
site map is not clear on how to navigate within the PQR tool section. The AMDS website does not
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 50
contain a site map. Both websites provide useful general search engines, medicines can be
searched by INN name. The GPRM on the AMDS website and the PQR tool on the GF website
only list ARV, anti-TB and anti-malaria medicines therefore only INN names in these three
categories link to results. Search results on both websites link to background information and
news events on the medicine but do not link to price information.
Basis for access
Both websites provide medicine price information free of charge and without the need for
registration.
Accessibility of information
On both websites medicine price information can be accessed in less than 10 mouse clicks. As
such both websites therefore score well on this indicator of information accessibility.
Both websites also provide medicine price information in an online database. The PQR tool on
the GF website, contains a product catalogue which lists prices and can be searched by purchase
order date, invoice date, last modified date, INCO term or therapeutic category. All search results
are alphabetically listed by INN name.
The prices in the Global Price Reporting Mechanism (GPRM) database of the AMDS website can
be searched by therapeutic category, INN name, dosage strength, dosage form, name and
country of manufacturer and purchase order date. All search results are alphabetically listed by
the name of the country that purchased the order.
The prices on both websites are published on the website and can be exported (complete
database or specific search results) into various formats (excel, pdf, other). There is no print
version of the price database or search results available on either the GF or AMDS websites.
Speed to search page
The download time at 56K per second was less than 60 seconds on both websites. Medicine
price information can therefore be obtained in a reasonable timeframe. On the AMDS website
the download time was less than 30 seconds.
Author information
The GF website discloses the source/author by providing detailed background information on the
Global Fund and on the Price & Quality Reporting Tool. Contact information specific for the PQR
author is listed on the main webpage.
The AMDS website gives full disclosure of the source/author by providing detailed background
information on the Global Price Reporting Mechanism (GPRM). Contact information for the AMDS
is listed, but no contact information is specified for the price database author.
Links
The GF website displays some useful links, including links to the WHO GPRM. The AMDS does
not link to other price reporting websites but does link to other organizations working on
HIV/AIDS.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 51
Clinton Foundation & Médecins Sans Frontières (Doctors Without Borders)
The Clinton Foundation (CF) and Médecins Sans Frontières (MSF) are reported together as both
websites report ARV medicines and several of the ex-factory prices reported on the MSF website
are reduced prices (for developing countries) negotiated by the Clinton Foundation at various
manufacturers. The way in which the prices are presented on the website are therefore
interesting to compare (same prices) to identify differences in how the same results could be best
presented.
Table 14: Summary of qualitative analysis of Clinton Foundation (CF) and Médecins Sans Frontières (MSF) websites
PRICE
GUIDE
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed to
search
page
Author
info
Links
CF 2 1 2 2 1 1 1 0
MSF 2 0.5 0 2 1.3 2 2 1
CF = Clinton Foundation; MSF = Médecins Sans Frontières;
User-friendliness
The Clinton Foundation (CF) and the Médecins Sans Frontières (MSF) website both receive a
high score on this criterion. They display a clear layout; as an example, the CF website is clearly
divided into 4 sections: ' what we do', 'explore our work', 'how you can help' and 'about the Clinton
Foundation'. This makes the website more accessible and facilitates navigation through the
webpage.
The entire contents of both websites are available in English.
Update: site & price information
Neither website displays the date of last update of the general website, though both specify the
date of last update of the price data reported. The price information on the CF website was
updated less than one month from the date of access, resulting in a combined score of 1 for this
criterion. The price information on the MSF website was last updated more than one month, but
less than one year from the date of access, resulting in a combined score of 0.5.
Site map / search
The CF website includes both a site map and a useful search engine. Medicines can be searched
by INN name, because only antiretroviral (ARV) medication is reported on this website, therefore
only the INN names of ARVs can be used to search the website. The search results link to both
the most recent and previous pricelists, background information on the medicine and
news/events.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 52
Basis for access
Both websites provide medicine price information free of charge and without the need for
registration
Accessibility of information
On both websites medicine price information can be accessed in less than 10 mouse clicks. The
websites therefore score well on this indicator of information accessibility.
The MSF website also provides a search option within the price information. All prices can be
viewed in a summary table; alternatively, prices can be searched by therapeutic class, INN name
(alphabetical list to select from) or manufacturer name (alphabetical list to select from).
The CF website includes a download version of the pricelist but no search option within this
document is provided. Prices are divided into 2 categories (adult products, pediatric products)
and are listed alphabetically by INN name. There is no print version of the pricelist on the CF
website, while the price database on the MSH website does not provide the option to download or
print either search results or the complete database.
Speed to search page
The download time at 56K per second was less than 60 seconds for both websites. Information is
therefore obtainable in a reasonable timeframe. The download time on the CF website was less
than 30 seconds.
Author information
The MSF website discloses the source/author by providing detailed background information on
HIV/AIDS treatment, on work done by MSF to date and on new projects and goals. In addition,
contact information specific to the MSF Campaign for Access to Essential Medicines is listed on
the main webpage.
The CF website publishes detailed background information on the Clinton Foundation and its
projects and initiatives’, including Clinton Health Access Initiative (CHAI), but no contact
information for CHAI is listed.
Links
Neither website includes links to other price reporting websites. However, the MSF website does
provide links to other organizations working on HIV/AIDS.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 53
Common European Drug Database, Management Sciences for Health & Österreichisches Bundesinstitut für Gesundheitswesen (Austrian Federal Institute for Health Care)
The websites of the Common European Drug Database (CEDD), Management Sciences for
Health (MSH) and the Österreichises Bundesinstitut für Gesundheitswesen (ÖBIG) are grouped
because they all report the prices of various countries for all globally available medicines. All
three sources are important multi country price information websites.
Table 15: Summary of qualitative analysis of Common European Drug Database (CEDD), Management
Sciences for Health - International Drug Price Indicator Guide (MSH - IDPIG) and Österreichisches
Bundesinstitut für Gesundheitswesen - Pharma Price Information (ÖBIG - PPI) websites
PRICE
GUIDE
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed to
search
page
Author
info
Links
CEDD 2 0/0.5 2 2 1.3 2 2 2
MSH - IDPIG 2 0 1 2 1.7 2 1 2
ÖBIG - PPI 2 0/1 1 0 0.7 1 2 0
CEDD = Common European Drug Database; MSH = Management Sciences for Health; IDPIG = International Drug Price
Indicator; ÖBIG = Österreichisches Bundesinstitut für Gesundheitswesen; PPI = Pharma Price Information;
User-friendliness
All three website receive a high score on this criterion. They display a clear layout; as an
example, the ÖBIG website is clearly divided into 4 sections: ' about us’, 'areas ', 'subjects' and
‘products'. This makes the website more accessible and facilitates navigation' through the
webpage.
The entire contents of the MSH and ÖBIG websites are available in English. The MSH website is
also available in French and Spanish, while the ÖBIG website is also available in German. The
CEDD webpage differs in that product names and dosage forms are listed in the national
language of the purchasing country (German, Czech, Finnish, Hungarian, Irish, Latvian,
Lithuanian, Norwegian, Polish, Slovakian or Slovenian), while all other content is in English.
Update: site & price information
None of the websites provide information on the date of last update of the general website.
However, the CEDD and MSH - IDPIG website provide the date of last update of the price data
reported.
The price information on the CEDD website was updated less than one month ago for some
countries, while other countries last updated their information more than one year ago. The
website states:
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 54
“The National Health Insurance Fund Administration of Hungary (OEP) maintains the website
cedd.oep.hu; the general website characteristics are not influenced by the participating countries.
Unfortunately, the country specific database is not always up-to-date (meanwhile changes in
prices will not be instantly executed in the database). However, these data are based on the
information of the authorities of the participating countries. Meaning that the criteria price
information (e.g. updates) and author information are the responsibility of the individual countries
and not that of OEP.”
All price data on the MSH website is updated on a yearly basis. On the date of access, price data
was from 2008 and thus was last updated over one year ago.
The ÖBIG -PPI website conducts price queries upon request, this way always the most recent
data used, but it is unknown whether the most recent data is from more than one month ago or
more than one year ago. This site therefore receives a score of 0, 0.5 or 1 depending on the
currency of the price information used (0 if price data > 1year old; 0.5 if price data>1month to
1year old; 1 if price data<1month old).
Site map / search
The CEDD website includes both a site map and a useful search engine. Searches can be
performed by country (alphabetical listing by medicine name) or by the medicine specific
Anatomical Therapeutic Chemical (ATC) code.
The MSH website does not include a site map; however it does have a useful search engine in
which medicines can be searched by INN name and the search results link to the most recent
prices available for the medicine.
The ÖBIG website also contains a search engine, but searches by either INN name or brand
name are not possible because medicine price information is provided upon request and is not
published on the website.
Basis for access
The CEDD and MSH - IDPIG website provide medicine price information free of charge and
without the need for registration. On the OBIG - PPI website medicine prices are only accessible
after query request and payment (no internet database).
Accessibility of information
On all three websites medicine price information can be accessed in less than 10 mouse clicks
(for ÖBIG -PPI this is the query request page with an example document). The websites therefore
score well on this indicator of information accessibility.
Price information on the CEDD webpage can be searched by country name or by ATC code.
The medicines in the MSH - IDPIG online database can be searched alphabetically, by INN
name, or by WHO EML Therapeutic Class. The ÖBIG -PPI website does not contain an online
database; therefore the availability of a search option is not applicable.
On the MSH - IDPIG website, all prices can be viewed in a summary table or medicines can be
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 55
searched by therapeutic class, INN name (alphabetical list to choose from) or manufacturer name
(alphabetical list to choose from).
Of the three websites only the MSH - IDPIG price database enables a download of the complete
database in pdf format. Neither three websites provide a direct print option.
Speed to search page
The download time at 56K per second was less than 60 seconds for all three websites.
Information is therefore obtainable in a reasonable timeframe. The download time on the CEDD
and MSH websites was less than 30 seconds.
Author information
The CEDD website discloses source information by providing an introduction on the CEDD
project and participating countries, as well as contact information for the CEDD author in the
National Health Insurance Fund Administration of Hungary (OEP).
The ÖBIG website provides both detailed background information on ÖBIG and its Pharma Price
Information service (PPI), and specific contact information for price (PPI) authors.
MSH publishes detailed background information on the International Drug Price Indicator Guide
(IDPIG) as well as general contact information for MSH, but no contact information is provided for
the authors of the medicine price data.
Links
Both the CEDD and MSH websites link to other price reporting websites, resulting in score 2 for
this criterion.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 56
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 57
International Trade Centre & WHO databases & Health Action International &
UNICEF
The pricing websites of the World Health Organization (WHO) regions (e.g. AFRO and PAHO)
and departments (e.g. Malaria Price Information Services) are grouped with the pricing websites
of the International Trade Centre (ITC - MNS report), Health Action International (HAI - Global
Database) and the United Nations Children's Fund (UNICEF). The latter three websites contain
price information collected in collaboration with the WHO. Table 16: Summary of qualitative analysis of International Trade Centre Market News Service for
Pharmaceuticals (ITC – MNS), WHO medicine price databases, Health Action International (HAI) Global
Database and UNICEF websites3
AFRO = Africa Regional Office; EM = Essential Medicines; HAI = Health Action International; ITC = International Trace Centre; MNS = Market News Service; MPIS = Malaria Price Information Services; RBM = Roll Back Malaria Partnership Secretariat; WHO = World Health Organization; PSI = Population Services International; MSH = Management Sciences for Health; PAHO = Pan-American Health Organization; PSM = Procurement & Supply Management; UNICEF = United Nations Children's Fund; User-friendliness
All six website receive a high score on this criterion. They display a clear layout with a logical
presentation of all available information and without any undesired advertisements.
All websites and price documents/databases are published in English. The general website of
AFRO is also available in French and Portuguese. The MNS report on the ITC website is
available upon request in English, Spanish, Portuguese or Chinese. The contents of the Malaria
Price Information Services (MPIS) are published on the general WHO website, which is available
3After the closing date of the qualitative analysis an additional website was identified for Health Action International. This website is
listed and analyzed individually in the qualitative analysis annex but not included in the analysis above, as it became available after the closing date of this comparative analysis.
PRICE GUIDE
User-
friend-
liness
Update:
site &
price
Site
map /
Search
Basis
for
access
Accessi-
bility
of info
Speed to
search
page
Author
info
Links
AFRO - EM 2 0 2 2 1 2 1 2
HAI Global
Database
2 0 1 2 1.3 2 0 0
ITC - MNS 2 1 1 0 1 2 2 1
MPIS
RBM/WHO/
UNICEF/PSI/MSH
2 0 1 2 1 2 1 1
PAHO - PSM 2 0 2 2 1 2 1 1
UNICEF
WHO cooperation
2 2 1 2 1 2 2 1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 58
in Arabic, Chinese, English, French, Russian and Spanish. The price document of MPIS is
available in English and French. The PAHO website is available in English and Spanish. The
general UNICEF website is also available in Arabic, Chinese, French and Spanish.
Update: site & price information
Only the UNICEF website provides information on the date of last update of the general website,
which was carried out less than one month from the date of access. The copyright dates are
noted on the AFRO (2009) and MPIS (2010) websites, but this does not say anything about the
currency of the site's contents. The ITC website has recently been renewed and the date of
creation is stated as 2010, but this also does not provide reliable insight into the last update of the
contents.
The price information on the ITC (bimonthly MNS report) and UNICEF websites was updated less
than one month from the date of access. On all other website the last update of price data was
more than one year ago. The HAI Global Database price information is based on previous
surveys in WHO regions or countries, the most recent survey used is dated December 2006.
Site map / search
The AFRO and PAHO websites include both a site map and useful search engine. Medicines can
be searched by INN name and search results link to background information and news events on
the medicine, but not to the price information.
The other websites also contain a useful search engine which enables medicines to be searched
by INN name. Search results on the ITC site link to the (sample) price document, background
information and news events on the medicine. On the other websites results do not link to prices.
Basis for access
With the exception of the ITC website, free access to price information is provided by all of the
websites and registration is not required. The bimonthly ITC MNS report on pharmaceutical
starting materials is free to access for users from developing countries, but users from developed
countries need a subscription to gain access to the reports.
Accessibility of information
On all websites the price information can be accessed in less than 10 mouse clicks. The websites
therefore score well on this indicator of information accessibility.
The price information on the AFRO, ITC, MPIS, PAHO and UNICEF websites is only available in
a download format and there is no search option within this document. All medicines are listed
alphabetically by INN name within this document (4 documents for PAHO: anti tuberculosis
medicines, anti malaria medicines, anti Chagas medicines, antiretrovirals (HIV/AIDS)). Essential
medicines within the UNICEF price document are divided into disease categories and within
these, medicine categories are listed alphabetically by INN name. A direct print option is not
available on any of the websites.
The HAI Global Database is an online database and can be searched by INN name, query type,
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 59
dosage strength, dosage form, public sector, private sector, reference data source and survey
(author name and publication date listed). It is not possible to view the entire database and a
download or print format of the price information is not provided on the website, however upon
request the data can be made available in a format that allows these functions.
Speed to search page
The download time at 56K per second was less than 30 seconds for all websites. Information is
therefore obtainable in a good timeframe.
Author information
On the AFRO website, disclosure of the source/author of the AFRO website is provided through
detailed background information on the Essential Medicines programme. General contact
information for AFRO and specific contact information for agencies that provide price information
is listed; however upon checking it was found that not all this contact information was still up-to-
date.
On the HAI Global Database website no information is provided on the source/author of the
website, no background information or general information on HAI is listed and no contact
information for HAI is available. For each individual price survey however contact information is
listed, including methods, results and discussion of each survey.
On the ITC website, disclosure of the source/author is provided, including detailed background
information on ITC in general and on the Market News Services (MNS) which is responsible for
the PSM report. General contact information is listed, together with a contact form to fill in to
contact the MNS team. A listing of price information providers is available at the end of the report.
On the MPIS webpage detailed background information on Roll Back Malaria Partnership (RBM)
and contact information of all organizations working on this project is listed; however upon
checking it was found that not all this contact information was still up-to-date.
The PAHO website discloses its source/author with detailed background information on Strategic
Fund and direct contact information for the author of the price documents.
On the UNICEF website detailed background information (including methods, results, discussion
of survey used to collect medicine prices) on the price report and contact information of
responsible department of WHO and UNICEF are listed.
Links
Only the AFRO and UNICEF websites link to other price reporting websites; they also list some
useful links to other organizations working on essential medicines and to other websites of the
United Nations System of Organizations.
The ITC and MPIS websites list some useful links to related organizations working on essential
medicines. The PAHO website links to related organizations and governmental authorities and
news events.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 60
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 61
V - 2. Quantitative Analysis
Web-based information can be used for external reference pricing, whereby the criterion (or one
of the criteria) for setting the national regulated price is based on the prices in other countries.
However, a lack of comparability of price data across sites may limit the usefulness of the
analysis. To assess the feasibility of comparing web-based medicine pricing information from
different sources, a quantitative analysis was carried out on 7 of the 14 medicines collected
globally in WHO/HAI surveys.
Almost all websites included in the qualitative analysis were also included in the quantitative
analysis. Although the same inclusion and exclusion criteria were applied (e.g. recent price
information, no entry fee, no commercial websites), nine websites included in the site and price
quality review were excluded from price comparisons.
For example, the United Kingdom the BNF website was not included in the price comparisons
because the price information was not free to access and thus was not publicly available.
Another primary reason for exclusion was that for some countries two or more sources reported
the same price information (some countries have multiple price source websites). When this was
the case, only the most recent price data source was included in the analysis (if the price date
was similar both sites were included. Exclusion because of duplicate price information was
initially the case for France (Codage and CEPS), Norway (CEDD and NMA), South Africa (MP
and DMP), Spain (AEMPS and Vademecum), the United Kingdom (reimbursement sources) and
the United States of America (reimbursement sources). Upon checking however, it was found that
the websites of the UK (Drug Tariff Scotland and Drug Tariff England & Wales) and USA
(MEDICAID and Kentucky MEDICAID) sometimes published different prices and therefore they
were all included in the analysis. For the remaining countries prices were double-checked on the
duplicate website, but the primary sources were as follows: France Codage, Norway NMA, South
Africa DMP and Spain AEMPS (abbreviations were derived from qualitative analysis).
For Canada and Portugal only one out of the two country price source websites was used,
because the other website only published originator brand products (which were excluded from
analysis). The primary sources for these countries were thus, Canada OPDP and Portugal
generic.
Lastly, the South African TAC website and the USA CDC website were not used in the price
comparisons, because neither published price information on any of the selected medicines on
their websites.
The remaining 41 national price sources were used for the international price comparisons of the
7 selected medicines. Price adjustments, as discussed in methods section, were made whenever
sufficient information was available to do so; however in some cases websites did not include the
necessary data to perform the adjustments.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 62
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 63
Amitriptyline 25mg capsules/tablets Price information on amitriptyline 25mg cap/tab is available from 36 sources, representing 33
countries. Table 17 shows a summary of the results for all these countries. All ratios mentioned in
the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for
amitriptyline 25mg, which is 0.0059 US$ per capsule or tablet. Summary tables are provided for
all national sources as well as for sources in the EURO region. For the other WHO regions the
results are summarized in the text, as the number of sources was too low to enable a tabular
summary. But detailed tables with results for all regions can be found in Annex XIV.
Table 17: Ratio of national medicine price to MSH reference price for Amitriptyline 25mg cap/tab, all national sources #1
All National price sources (n=36)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Amitriptyline 25mg 0.0059 US$ per cap/tab = MSH ratio 1.00
n = 9 n = 6 n = 11 n = 12 n = 21 Median Ratio 6.95 2.21 9.15 --- 9.15 Mean Ratio 6.76 3.23 7.07 --- 10.0 Lowest Ratio 2.54 0.41 2.37 2.78 1.47 Highest Ratio 10.3 10.0 10.7 69.5 16.3 High/Low Ratio 4.1 24.6 4.5 25.6 11.0
#1 Please see section IV.4 for all data limitations;
For amitriptyline 25 mg, the availability of price data varied across the different price types. The
price type with the largest number of prices found was retail/patient prices (n=21), while few price
points were found for ex-factory and procurement prices (n=9 and n=6, respectively).
Table 17 shows H/L ratios are below 10.0 for ex-factory and wholesale price types. The H/L ratios
for procurement and reimbursement prices are however more than twice as high (24.6 and 25.6,
respectively). Such large variations in price cannot be justified by comparability issues alone.
Looking at procurement it must be noted that India is the only country with a price below the MSH
reference price (MSH ratio 0.41). The detailed summary table (Annex XIV) shows Denmark has
the highest ratio - 10.0 times above the MSH reference price, and the other 4 procurement prices
are within the range 1.47 to 3.05. This establishes that the high H/L ratio is due to high prices in
Denmark. For reimbursement the high H/L ratio could be explained by the specific data limitations
for this price type, some sources report ceiling prices, while others report the lowest and highest
reimbursed prices. Taking the data limitations for this price type in account it is not possible to
calculate a median or mean ratio for this price type.
Furthermore it must be noted that none of the prices, except for the procurement prices from
India, were below the MSH reference price of 0.0059 US$. All calculated median and mean ratios
are relatively high; the median MSH ratios range from 2.21 (procurement) to 9.15 (wholesale and
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 64
retail/patient) and mean MSH ratios range from 3.23 (procurement) to 10.0 (retail/patient).
Ex-factory and wholesale prices have the lowest H/L ratio, meaning that these price types had the
lowest amount of variation across sources. However, in all cases prices were above the MSH
price. And while it is expected that retail prices will be higher than MSH prices as the latter do not
include local distribution costs, average retail prices of over ten times the MSH price are still
considered high.
Table 18: Ratio of national medicine price to MSH reference price for Amitriptyline 25mg cap/tab, EURO region#1
WHO Region EURO (n=21)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Amitriptyline 25mg 0.0059 US$ per cap/tab = MSH ratio 1.00
n = 7 n = 2 n = 9 n = 7 n = 16 Median Ratio 6.95 --- 9.15 --- 9.92 Mean Ratio 6.90 5.74 6.99 --- 10.6 Lowest Ratio 2.54 1.47 2.37 2.78 4.92 Highest Ratio 10.3 10.0 10.7 50.8 16.3 High/Low Ratio 4.1 6.8 4.5 18.8 3.3
#1 Please see section IV.4 for all data limitations;
Table 18 shows the available data for the EURO region. A total of 21 sources, representing 20
countries, reported price information on amitriptyline 25mg capsules/tablets. None of the
countries has a price below the MSH reference price in any of the price categories. However, the
lowest ratios reported for wholesale and reimbursement in the EURO region (ratios 2.37 and
2.88, respectively) are also the lowest of all national price sources. For the ex-factory price
category 7 countries reported prices. France reports the highest price (MSH ratio 10.3), but this
price is only slightly higher than that of two other (also high-income) countries: Spain (ratio 10.0)
and Austria (ratio 9.15). Furthermore it should be noted that for this price type, high income
countries display a great variation in prices (ratios ranging from 4.24 to 10.3), while the upper-
middle income countries Lithuania and Slovakia report more comparable prices (ratio 2.54 and
4.92, respectively). The procurement prices from Denmark and the UK are above the MSH
reference price of 0.0059 US$. The Danish price is the highest of all national price sources with a
ratio of 10.0, while the UK price is the second lowest price of all national price sources (ratio
1.47). Nine countries report wholesale prices, 7 of them being high-income countries. With the
exception of Ireland (ratio 2.37) all high-income countries report high prices with rations ranging
from 6.95 (Hungary) to 9.32 (Finland). The upper-middle income countries Latvia and Lithuania
report substantially lower prices with ratios of 2.37 and 2.54, respectively. The low ratio for Latvia
is also the lowest of all national sources reporting wholesale prices. Reimbursement prices are
reported by 7 countries in the EURO region. Taking the data limitations for this price type into
account it is difficult to compare this price type between sources. All report their lowest and
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 65
highest reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources
from EURO report retail/patient prices, all have prices higher than the MSH reference price. Only
Latvia and Lithuania (ratio 4.92 for both) report prices that are less than 5 times as high as the
reference price. All remaining 14 countries report prices of at least 5 times as high (ratios ranging
from 6.10 to 16.3); moreover for 8 countries (all high-income) the retail/patient price is more than
10 times as high as the reference price (ratios ranging from 10.7 to 16.3). These high ratios could
be partially explained by the fact that MSH prices do not include local distribution costs, but this
alone does not account for up to 16-fold differences.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in this region. Of the three price sources from South Africa, only one
provided actual price information on amitriptyline 25mg capsules/tablets. Both ex-factory and
wholesale prices reported are above the MSH reference price of 0.0059 US$ with ratios of 8.31
and 10.3, respectively. Looking across other upper-middle income countries, the South African
ex-factory price is relatively high (ratios ranging from 2.54 to 6.95). The same can be said of the
wholesale price reported compared to all other national sources from the upper-middle income
category (ratios ranging from 2.37 to 6.95).
For the AMRO region 7 sources are available, representing 3 countries. Of these sources, one
Brazilian, one Canadian and 3 USA websites reported price information on amitriptyline 25mg
capsules/tablets. The procurement prices from both Brazil and USA were above the MSH
reference price with ratios of 1.54 and 2.88, respectively. Both prices score just below average in
their price category with all national price sources. For reimbursement prices 3 prices were
reported one for Canada (ratio 12.9) and two for the USA (ratio 7.46 and 15.9). Taking the data
limitations for this price type into account it is difficult to compare this price type between sources.
Canada reports a price ceiling, leading to a high MSH price ratio compared to the USA source
and to the MSH reference price.
For the EMRO region 8 sources are available, representing 8 countries. Six of these countries
reported price information on amitriptyline 25mg capsules/tablets. All prices reported for the
countries in this region are above the MSH reference price of 0.0059 US$. For procurement
Sudan is the only country in the EMRO region reporting a price. With a ratio of 3.05 this price is
high for a low-income country (MSH ratio of India is only 0.41). It is the second highest price for
all national sources; due to Denmark (ratio 10.0), Sudan's procurement price is still below the
mean for all countries in its price category. Jordan’s wholesale price (ratio 4.58) is below the
mean (ratio 7.07) and median price (ratio 9.15) for all national price sources in this category. It is
however relatively high for a lower-middle income country, all other national sources in this
category are upper-middle and high-income countries and do not all have much higher prices,
some are even lower (ratios ranging from 2.37 to 10.7). This shows that lower-income countries,
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 66
like Jordan, sometimes pay more for medicines than high-income countries. The reimbursement
price for Morocco is the maximum reimbursed price (ratio 12.9), but little can be said about this
price type because of its data limitations. Six countries in the EMRO region reported retail/patient
prices. The price reported in Iran (ratio 1.47) is the lowest retail/patient price for amitriptyline
across all national price sources, while the Oman price (ratio 16.3) is the highest across all
national price sources. For Oman, as an upper-middle income country, it is notable that its price
is higher than that of all high-income countries. Out of the six countries reporting retail/patient
prices in the EMRO region, all lower-middle income countries (Iran, Jordan, Morocco and Tunisia)
have lower prices than Oman. It must be noted, however, that only the prices from Iran (ratio
1.47), Jordan (ratio 5.76) and Tunisia (ratio 4.24) are much lower; the price from Morocco (ratio
12.9) is closer to the price in Oman (ratio 16.3). One possible cause for this price variation could
be that it is unknown whether a dispensing fee and/or VAT/GST are included in each price; if
included the price may appear high in comparison to other retail prices that do not include these
costs. However this factor alone probably does not account for retail/patient prices that are up to
16 times higher than the MSH reference price.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in this region. Of the two price sources from India, only one provided price
information on amitriptyline 25mg capsules/tablets. The procurement price reported by this
source is the lowest of all the national price sources. The MSH price ratio of 0.41 shows the
Indian procurement price is only about half the international reference price.
For the WPRO region only 2 countries provide price information on medicines. New Zealand
reported ex-factory price information and Australia reported reimbursement price information on
amitriptyline 25mg capsules/tablets. For ex-factory New Zealand reported the second lowest price
(MSH ratio 4.24) for all national price sources; representing the lowest price for all high income
countries in this price type. Taking the data limitations for reimbursement prices in account it is
difficult to compare this price type between sources. Australia reports a price ceiling (ratio 49.2 to
69.5) leading to a high MSH price ratio compared to other national sources and to the MSH
reference price. The ceiling price of Australia is the highest for this price type across all national
price sources.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 67
Atenolol 50mg capsules/tablets
Price information on atenolol 50mg cap/tab is available from 37 sources, representing 34
countries. Table 19 shows a summary of the results for these countries. All ratios mentioned in
the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for atenolol
50mg, which is 0.0161 US$ per capsule or tablet. For all national sources and for all sources in
the EURO region a summary table is printed below. For the other regions the summary consists
of text alone, because the number of sources was too low to establish a clear overview in a table.
But detailed tables with results for all regions can be found in the Annexes (Annex XV).
Table 19: Ratio of national medicine price to MSH reference price for Atenolol 50mg cap/tab, all national sources#1
All National price sources (n=37)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Atenolol 50mg 0.0161 US$ per cap/tab
n = 8 n = 6 n = 11 n = 12 n = 21 Median Ratio 2.70 0.49 3.60 --- 4.41 Mean Ratio 3.45 1.08 4.84 --- 5.77 Lowest Ratio 0.56 0.12 1.06 2.17 0.68 Highest Ratio 8.70 4.10 12.4 25.5 16.8 High/Low Ratio 15.6 34.7 11.8 11.7 24.5
#1 Please see section IV.4 for all data limitations;
For atenolol 50 mg, the availability of price data varied across the different price types. The price
type with the largest number of prices found was retail/patient prices (n=21), while few price
points were found for ex-factory and procurement prices (n=8 and n=6, respectively).
Table 19 shows H/L ratios are more than 10.0 for every price type, excpt for ex-
factory/manufacturer prices. In particular for procurement and retail/patient the H/L ratio is very
high (34.7 and 24.5, respectively). Such large variations in price cannot be justified by
comparability issues alone. Looking at procurement it must be noted that although the H/L is high,
the median ratio is below 1.00 and the average ratio is just above with 1.08. The detailed
summary table (Annex XV) shows that only Sudan has the highest ratio - 4.10 times above the
MSH reference price, and the other 5 procurement prices are lower than the MSH reference price
of 0.0161US$. The latter 5 procurement prices are from high-income countries, showing that low-
income countries like Sudan can sometimes pay more for medicines than high-income countries.
However, this trend is not observed for other low-income countries. The H/L ratio of retail/patient
prices was also considered high (24.5); this high ratio could partially be explained by the price of
Iran which was below the MSH reference price, in contrast to all other prices (ratios ranging from
1.86 to 16.8). However, while it is expected that retail prices will be higher than MSH prices, as
the latter do not include local distribution costs, average retail prices of over six times the MSH
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 68
price are considered high. Wholesale and reimbursement prices have the lowest H/L ratios (11.8
and 11.7, respectively), meaning that these price types had the lowest amount of variation across
sources. However, for both these types all prices were above the MSH price and little price points
were available for comparison.
Table 20: Ratio of national medicine price to MSH reference price for Atenolol 50mg cap/tab, EURO region#1
WHO Region EURO (n=22)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Atenolol 50mg 0.0161 US$ per cap/tab = MSH ratio 1.00
n = 6 n = 2 n = 9 n = 8 n = 16 Median Ratio 2.95 --- 3.42 --- 4.22 Mean Ratio 4.11 0.64 5.16 --- 5.40 Lowest Ratio 1.68 0.40 1.06 2.55 1.86 Highest Ratio 8.70 0.87 12.4 23.6 13.7 High/Low Ratio 5.2 2.2 11.8 9.3 7.3
#1 Please see section IV.4 for all data limitations;
Table 20 shows all available data for countries in the EURO region. For this region 22 sources,
representing 21 countries reported price information on atenolol 50mg capsules/tablets.
None of the countries in the ex-factory price category has a price below the MSH reference price
of 0.0161 US$. It should also be noted that for this price type, most high income countries (except
for New Zealand (ratio 0.56)) have higher prices (ratios ranging from 3.17 to 8.70) than the upper-
middle income countries (ratios ranging from 1.68 to 2.67). Hungary reported the second lowest
ex-factory price for all national price sources in this category (ratio 1.68). For procurement prices,
Denmark and the UK were below the MSH reference price of 0.0161 US$. Nine countries report
wholesale prices, three of them (Austria, Ireland, Slovenia) have much higher prices (ratio 6.83 to
12.4) than the other six countries (ratio 1.06 to 5.09). The other countries have price comparable
to the average across all national sources with prices about 3 times as high as the MSH
reference price. Reimbursement prices are reported by 8 countries in the EURO region. Taking
the data limitations for this price type in account it is difficult to compare this price type between
sources. All report their lowest and highest reimbursed prices, leading to a great variation in MSH
price ratios. Sixteen price sources from EURO report retail/patient prices, all have prices higher
than the MSH reference price of 0.0161 US$. For 4 countries this price is more than 5 times as
high as the MSH reference price: Austria 13.7, Finland 9.32, France 8.70 and Italy 9.32. These
big differences could be partially explained by the fact that MSH prices do not include local
distribution costs, but this alone probably does not account for 5-fold differences.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on atenolol 50mg capsules/tablets. Both ex-factory and
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 69
wholesale price reported are above the MSH reference price of 0.0161 US$ with ratios of,
respectively 2.36 and 3.79. But both are below the ex-factory mean (ratio 4.11) and wholesale
mean (ratio 4.84) for all national sources. Thus, while the prices are relatively high compared to
MSH prices, they are not particularly high compared to all other national sources. Looking across
other upper-middle income countries, South African prices are comparable.
For the AMRO region 7 sources are available, representing 3 countries. One Brazilian, one
Canadian and 3 USA websites reported price information on atenolol 50mg capsules/tablets. The
procurement prices for both Brazil and USA were below the MSH reference price with ratios of,
respectively 0.46 and 0.52. For reimbursement 3 prices were reported, one for Canada (ratio
16.1) and two for the USA (ratio 2.17 and 3.11). Taking the data limitations for this price type in
account it is difficult to compare this price type between sources. Canada reports a price ceiling,
leading to a high MSH price ratio compared to the USA source and to the MSH reference price.
A total of 8 countries in the EMRO region publish price information on websites. Six of these
countries reported price information on atenolol 50mg capsules/tablets. For procurement Sudan
is the only country in the EMRO region reporting a price. With a ratio of 4.10 this procurement
price is the highest for all countries and the only one above the MSH reference price in its price
category. The wholesale price of Jordan is just above average across all countries, but higher
than for other lower-middle income countries. Five countries in the EMRO region reported
retail/patient prices. Iran was the only country for all national sources that reported a retail/patient
price below the MSH reference price (ratio 0.68). For Jordan, Lebanon and Oman this price is
comparable (ratios ranging from 5.22 to 7.45), while this price is substantially higher in Bahrain
(MSH ratio of 16.8). Bahrain had the highest retail/patient price for atenolol across all 37national
price sources. An explanation could be that it's unknown if a dispensing fee and VAT/GST are
included in this price; if included this price may appear high in comparison to retail prices that do
not include these costs. However this factor alone probably does not account for a price that is
more than double the average price across all countries.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in the SEARO region. Of the two price sources from India, only one provided
price information on atenolol 50mg capsules/tablets. The procurement price reported by this
source is the lowest of all the national price sources. The MSH price ratio of 0.12 shows the
Indian procurement price is only about one-eighth the international reference price.
For the WPRO region only 2 countries provide price information on atenolol 50mg
capsules/tablets. New Zealand reported the lowest ex-factory price for all national price sources
(MSH ratio 0.56). Moreover, it was the only country reporting a price below the MSH reference
price in its category; its price was only about half the international reference price. Australia
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 70
reported reimbursement price information on atenolol 50mg capsules/tablets. Taking the data
limitations for this price type in account it is difficult to compare this price type between sources.
Australia reports a price ceiling (ratio 19.3 to 25.5) leading to a high MSH price ratio compared to
other national sources and to the MSH reference price. The ceiling price of Australia is the
highest for this price type across all national price sources.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 71
Ciprofloxacin 500mg capsules/tablets Price information on ciprofloxacin 500mp cap/tab is available from 39 sources, representing 36
countries. Table 21 shows a summary of the results for all these countries. All ratios mentioned in
the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for
ciprofloxacin 500mg, which is 0.0372 US$ per capsule or tablet. For all national sources and for
all sources in the EURO region a summary table is printed below. For the other regions the
summary consists of text alone, because the number of sources was too low to establish a clear
overview in a table. But detailed tables with results for all regions can be found in the Annexes
(Annex XVI).
Table 21: Ratio of national medicine price to MSH reference price for Ciprofloxacin 500mg cap/tab, all national sources #1
All National price sources (n=39)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Ciprofloxacin 500mg 0.0372 US$ per cap/tab = MSH ratio 1.00
n = 8 n = 6 n = 11 n = 11 n = 24 Median Ratio 10.3 1.48 13.2 --- 13.0 Mean Ratio 13.1 2.52 17.5 --- 17.2 Lowest Ratio 2.69 0.51 2.23 2.96 2.34 Highest Ratio 30.6 6.45 39.5 44.4 45.9 High/Low Ratio 11.4 12.6 17.7 15.0 19.7
#1 Please see section IV.4 for all data limitations;
For ciprofloxacin 500mg, the availability of price data was high, but it varied across the different
price types. The price type with the largest number of prices found was retail/patient prices
(n=24), while few price points were found for ex-factory and procurement prices (n=8 and n=6,
respectively). The numbers of wholesale and reimbursement prices is similar (n=11).
Table 21 shows all H/L ratios are above 10.0 for all price categories. The H/L ratios for wholesale,
reimbursement and retail/patient prices are as high as 15.0 or even higher (17.7, 15.0 and 19.7,
respectively). Meaning that the prices in all the categories display a great variation between them;
such large variations in price cannot be justified by comparability issues alone. In the
procurement price category, India is the only country with a price below the MSH reference price
(MSH ratio 0.51). The detailed summary table (Annex XVI) shows Denmark has the highest ratio
- 6.45 times above the MSH reference price, while the other 4 procurement prices are more
comparable with ratios ranging from 1.18 to 4.03.
What must be noted is that none of the prices in any of the categories, except for the
procurement price of India, was below the MSH reference price of 0.0372 US$; and that all prices
seem to be relatively high. Excluding the procurement price type, all median ratios for the
different price categories are within a range of 10.3 (ex-factory) to 13.0 (retail/patient).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 72
Table 22: Ratio of national medicine price to MSH reference price for Ciprofloxacin 500mg cap/tab, EURO region#1
WHO Region EURO (n=22)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Ciprofloxacin 500mg 0.0372 US$ per cap/tab = MSH ratio 1.00
n = 6 n = 2 n = 9 n = 7 n = 16 Median Ratio 11.8 --- 13.4 --- 14.2 Mean Ratio 16.1 3.82 19.6 --- 18.9 Lowest Ratio 4.57 1.18 2.23 2.96 3.76 Highest Ratio 30.6 6.45 39.5 44.4 45.9 High/Low Ratio 6.7 5.5 17.7 15.0 12.2
#1 Please see section IV.4 for all data limitations;
Table 22 shows all available data for the EURO region. A total number of 22 sources,
representing 21 countries reported price information on ciprofloxacin 500mg capsules/tablets.
None of the countries has a price below the MSH reference price in any of the price categories.
All prices in countries are relatively high; the highest prices reported for this region are also the
highest of all national price sources, while only the wholesale price (MSH ratio 2.23) is the lowest
price in both the EURO region as for all national sources. Ex-factory and procurement prices
have the lowest H/L ratio, meaning that this price type had the lowest amount of variation across
sources. However, they also had the least price points available for comparison, so in this case
the low H/L ratio does not tell us as much. For the ex-factory price category 6 countries reported
prices. The prices of Austria and France (ratios 30.6 and 28.5, respectively) are remarkably
higher than the ex-factory prices reported by the other 4 countries in the EURO region (ratios
ranging from 4.57 to 12.4), but also compared to ex-factory prices reported by all other national
sources (ratios ranging from 2.69 to 12.4). Remarkable is that high-income country Spain reports
the second lowest ratio of 4.57 (after New Zealand (MSH ratio 2.69)), while the ratios of upper-
middle income countries Hungary, Lithuania and Slovakia are double as high as this lowest ratio
(ratios 9.41 and 12.4 and 11.3, respectively). The procurement prices of both Denmark and the
UK are above the MSH reference price of 0.0372 US$. The Danish price is the highest of all
national price sources with a ratio of 6.45, while the UK price is the second lowest price of all
national price sources (ratio 1.18). Nine countries report wholesale prices, 7 of them are high-
income countries. The two upper-middle income countries Latvia and Lithuania report almost the
same price with ratios of 13.2 and 13.4, respectively. The seven high-income report prices with a
great variation (ratios ranging from 2.23 to 39.5); the high outliers are Austria, Ireland, Norway
and Slovenia (ratios 34.1, 39.5, 32.8 and 27.9, respectively). Reimbursement prices are reported
by 7 countries in the EURO region. Taking the data limitations for this price type in account it is
difficult to compare this price type between sources. All report their lowest and highest
reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources from
EURO report retail/patient prices, all have prices higher than the MSH reference price of 0.0372
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 73
US$. Twelve of these countries are high-income countries; the remaining four are upper-middle
income countries. The upper-middle income countries Latvia and Slovakia report the same price
(ratio 16.4), Lithuania and Poland report (slightly) lower prices (ratio 15.9 and 10.2, respectively).
All prices reported by the high-income countries display a great variation (ratios ranging from 3.76
(Netherlands) to 45.9 (Austria). All high ratios could be partially explained by the fact that MSH
prices do not include local distribution costs, but this alone probably does not account for an
average 19-fold difference. Austria, France and Italy report very high prices that are more than 40
times as high as the MSH reference price (ratios 45.9, 43.0 and 40.9, respectively).
Specifically looking at Austria and France, it must be noted that although their prices are already
high in each price category, the price differences between the sectors in the distribution chain are
also remarkably high. For Austria the ex-factory price is 1.14 US$ (ratio 30.6), the wholesale price
is 1.27 US$ (+0.13 US$) (ratio 34.1 (+3.5)) and the retail/patient price is 1.71 US$ (+0.56 US$) (ratio 45.9
(+15.3)). For France the ex-factory price is 1.06 US$ (ratio 28.5) and the retail/patient price is 1.60
US$ (+0.54US$) (ratio 43.0 (+14.5)). Both examples suggest that high add-on costs in the distribution
chain can also be a factor leading to high prices.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on ciprofloxacin 500mg capsules/tablets. Both ex-factory
and wholesale price reported are above the MSH reference price of 0.0372 US$ with ratios of,
respectively 5.11 and 6.45. Looking across other upper-middle income countries, the South
African ex-factory price is low (ratios ranging from 9.41 to 12.4). The same can be said of the
wholesale price reported compared to all other national sources from the upper-middle income
class (ratios ranging from 10.2 to 13.4).
For the AMRO region 7 sources are available, representing 3 countries. Of these sources, one
Brazilian, one Canadian and two USA websites reported price information on ciprofloxacin 500mg
capsules/tablets. The procurement prices for both Brazil and USA were above the MSH reference
price with ratios of, respectively 1.40 and 1.56. Both prices score just below average in their price
category with all national price sources. For reimbursement 2 prices were reported, one for
Canada (ratio 30.6) and one for the USA (ratio 12.1). Taking the data limitations for this price type
in account it is difficult to compare this price type between sources. Canada reports a price
ceiling, leading to a high MSH price ratio compared to the USA source and to the MSH reference
price.
For the EMRO region 8 sources are available, representing 8 countries. All eight countries
reported price information on ciprofloxacin 500mg capsules/tablets. All prices reported for the
countries in this region are above the MSH reference price of 0.0059 US$. For procurement
Sudan is the only country in the EMRO region reporting a price. With a ratio of 4.03 this price is
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 74
high for a low-income country (MSH ratio of India is only 0.51). It is the second highest price for
all national sources and apart from Denmark (ratio 6.45) all the countries with a higher income
stay below Sudan's price (ratios ranging from 1.18 to 1.56). The wholesale price of Jordan (ratio
10.5) is below the mean (ratio 17.5) and median price (ratio 13.2) for all national price sources in
this category. The reimbursement price for Morocco is a range of the lowest and highest
reimbursed price (ratio 25.3 to 27.4), but not much can be said about this price type because of
its data limitations. Seven countries in the EMRO region reported retail/patient prices. The prices
of Bahrain and Morocco are the highest and were very much comparable (ratio 26.3 and 25.3,
respectively). This is remarkable looking at the income classes for the countries: Bahrain is high-
income and Morocco is lower-middle income. Moreover, the remaining five countries which
stayed below the price of Morocco include the upper-middle income countries Lebanon and
Oman (ratio 12.1 and 12.4, respectively). Showing countries with lower incomes, like Morocco,
sometimes pay more for medicines than countries with higher incomes. Iran reported the lowest
retail/patient price for all national sources (ratio 2.34). The prices reported by Jordan, Lebanon,
Oman and Tunisia were comparable (ratios 13.4, 12.1, 12.4 and 14.2, respectively). Once again it
must be noted that the lower-middle income countries Jordan and Tunisia reported higher prices
than the two upper-middle income countries, although the differences are small.
An explanation for the great variation in retail/patient prices between the countries in the EMRO
region, could be that it's unknown if a dispensing fee and VAT/GST are included in the prices; if
included this price may appear high in comparison to retail prices that do not include these costs.
However this factor alone probably does not account for a retail/patient price that is up to 26
times as high as the MSH reference price.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in the SEARO region. Both sources reported price information on ciprofloxacin
500mg capsules/tablets. The procurement price reported is the lowest of all the national price
sources and the only one in any of the categories that is below the MSH reference price of 0.0372
US$. The MSH price ratio of 0.51 shows the Indian procurement price is only about half the
international reference price. The retail/patient price is the second lowest of all the national price
sources with a ratio of 3.49. A remark for this price is that it's a ceiling price, the maximum price
allowed to be paid for this medicine. Although in their own price types they are both considered
low prices, the difference between them is high (ratio 0.51 vs. ratio 3.49).
For the WPRO region only 2 countries provide price information on medicines. New Zealand
reported ex-factory price information on ciprofloxacin 500mg capsules/tablets, while Australia
reported reimbursement price information. The ex-factory price of New Zealand was the lowest
for all national price sources in its category (MSH ratio 2.69). Remarkable is that high-income
country New Zealand reports the lowest ex-factory price ratio, while the upper-middle income
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 75
countries report price ratios of at least double as high (ratios ranging from 5.11 to 12.4). It is
difficult to compare the reimbursement price of Australia due to the data limitations for this price
type. Australia reports a price ceiling (ratio 27.4) leading to a high MSH price ratio compared to all
national sources and to the MSH reference price.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 76
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 77
Glibenclamide 5mg capsules/tablets
Price information on glibenclamide 5mg cap/tab is available from 30 sources, representing 27
countries. Table 23 shows a summary of the results for all these countries. All ratios mentioned
in the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for
glibenclamide 5mg, which is 0.0045 US$ per capsule or tablet. For all national sources and for all
sources in the EURO region a summary table is printed below. For the other regions the
summary consists of text alone, because the number of sources was too low to establish a clear
overview in a table. But detailed tables with results for all regions can be found in the Annexes
(Annex XVII).
Table 23: Ratio of national medicine price to MSH reference price for Glibenclamide 5mg cap/tab, all national sources #1
All National price sources (n=30)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Glibenclamide 5mg 0.0045 US$ per cap/tab = MSH ratio 1.00
n = 8 n = 5 n = 6 n = 10 n = 17 Median Ratio 4.56 1.93 13.0 --- 11.6 Mean Ratio 8.81 2.54 13.7 --- 15.5 Lowest Ratio 2.89 0.16 3.33 12.2 2.22 Highest Ratio 20.9 4.89 24.4 62.2 51.1 High/Low Ratio 7.2 30.1 7.3 5.1 23.0
#1 Please see section IV.4 for all data limitations;
For glibenclamide 5 mg, the availability of price data was lower than for the other medicines
reviewed. The price type with the largest number of prices found was retail/patient prices (n=17),
while few price points were found for procurement and wholesale prices (n=5 and n=6,
respectively).
Table 23 shows H/L ratios are below 10.0 for the price types ex-factory, wholesale and
reimbursement. The H/L ratios for retail/patient prices and in particular for procurement prices are
however much higher (23.0 and 30.1, respectively). Such large variations in price cannot be
justified by comparability issues alone. In the procurement price category, India is the only
country with a price below the MSH reference price (MSH ratio 0.16). The detailed summary table
(Annex XVII) shows Sudan has the highest ratio - 4.89 times above the MSH reference price, and
the other 3 procurement prices are within the range 1.73 to 4.00. That Sudan as a low-income
country has the highest procurement price, as opposed to India who has the lowest price, is
remarkable.
Furthermore it must be noted that none of the prices, except for the procurement price of India,
was below the MSH reference price of 0.0045 US$, and that all prices seem to be relatively high.
Excluding the procurement price type, all median ratios for the different price categories are
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 78
within a range of 4.56 (ex-factory) to 13.0 (wholesale). A reason for this could be that
glibenclamide is not the first choice in anti-diabetes treatment, which might result in less generic
competition and thus higher price. A few sources only reported lower dosage strengths or the
originator brand, which was excluded in this research.
For retail/patient prices the high H/L ratio (23.0) could be explained by the data limitations. Taking
into account that it is not always certain whether or not VAT/GST and a dispensing fee are
included. While it is expected that retail prices will be higher than MSH prices, as the latter do not
include local distribution costs, average retail prices of over sixteen times the MSH price are
considered high.
Table 24: Ratio of national medicine price to MSH reference price for Glibenclamide 5mg cap/tab, EURO region#1
WHO Region EURO (n=15)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Glibenclamide 5mg 0.0045 US$ per cap/tab = MSH ratio 1.00
n = 7 n = 1 n = 4 n = 5 n = 11 Median Ratio 4.44 --- 20.1 --- 14.9 Mean Ratio 9.40 --- 17.0 --- 15.3 Lowest Ratio 2.89 1.93 3.33 12.2 2.89 Highest Ratio 20.9 --- 24.4 48.9 35.6 High/Low Ratio 7.2 --- 7.3 4.0 12.3
#1 Please see section IV.4 for all data limitations;
Table 24 shows all available data for countries in the EURO region. For this region 15 sources,
representing 14 countries reported price information on glibenclamide 5mg capsules/tablets.
None of the countries has a price below the MSH reference price in any of the price categories.
However, the lowest ratios reported for wholesale, reimbursement and retail/patient in the EURO
region (ratios 3.33 and 12.2 and 2.89, respectively) are also the lowest of all national price
sources.
For the ex-factory price category 7 countries reported prices. It should be noted that for this price
type, high income countries display a great variation in prices (ratios ranging from 2.89 to 20.9),
while the upper-middle income countries report exactly the same price (ratio 3.11). The
procurement price for the UK is above the MSH reference price of 0.0045 US$ and represents
the median of all national price sources. Four countries report wholesale prices, three of them
(Austria, Ireland, Slovenia) have much higher prices (ratio 18.0 to 24.4) even far above the mean
(ratio 13.7) and median price (ratio 13.0) for all national price sources. Lithuania scores well with
a low ratio of 3.33. Reimbursement prices are reported by 5 countries in the EURO region. Taking
the data limitations for this price type in account it is difficult to compare this price type between
sources. All report their lowest and highest reimbursed prices, leading to a great variation in MSH
price ratios. Eleven price sources from EURO report retail/patient prices, all have prices higher
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 79
than the MSH reference price of 0.0045 US$. Remarkable is that all three upper-middle income
countries (Lithuania, Slovakia and Slovenia) report exactly the same price and with a ratio of 3.33
these are below the median price (ratio 12.6) and the mean price (ratio 16.4) for all national
sources. The Czech Republic has the second lowest ratio with 2.89. The remaining 8 countries
report much higher prices (ratios ranging from 6.89 to 35.6); these big differences could be
partially explained by the fact that MSH prices do not include local distribution costs, but this
alone probably does not account for up to 35-fold differences.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on glibenclamide 5mg capsules/tablets. Both ex-factory and
wholesale price reported are above the MSH reference price of 0.0045 US$ with ratios of,
respectively 4.67 and 6.22. But both are below the ex-factory mean (ratio 8.07) and wholesale
mean (ratio 13.7) for all national sources. The wholesale price is also below the median (ratio
13.0) for all national price sources. Thus, while the prices are relatively high compared to MSH
prices, they are not particularly high compared to all other national sources. Looking across other
upper-middle income countries, South African prices are relatively high.
For the AMRO region 7 sources are available, representing 3 countries. One Brazilian, one
Canadian and 3 USA websites reported price information on glibenclamide 5mg capsules/tablets.
The procurement prices for both Brazil and USA were above the MSH reference price with ratios
of, respectively 1.73 and 4.00. For reimbursement 3 prices were reported, one for Canada (ratio
13.8) and two for the USA (ratio 42.2 and 62.2). Taking the data limitations for this price type in
account it is difficult to compare this price type between sources. Canada reports a price ceiling,
leading to a high MSH price ratio compared to the USA source and to the MSH reference price.
Even so, it is still very remarkable that the ratios for the USA are this high.
For the EMRO region 8 sources are available, representing 8 countries. Seven of these countries
reported price information on glibenclamide 5mg capsules/tablets. All prices reported for the
countries in this region are above the MSH reference price of 0.0045 US$. For procurement
Sudan is the only country in the EMRO region reporting a price. With a ratio of 4.89 this price is
the highest for all countries in its price category. Compared to all other countries reporting this
price Sudan’s price is not particularly high (ratios ranging from 1.73 to 4.00), however it is high
compared to other low-income countries. The wholesale price of Jordan (ratio 8.00) is below the
mean (ratio 13.7) and median price (ratio 13.0) for all national price sources in this category. The
reimbursement price for Morocco is a range of the lowest and highest reimbursed price (ratio 13.6
to 22.2), but not much can be said about this price type because of its data limitations. Six
countries in the EMRO region reported retail/patient prices. Iran reports the lowest price for all
national price sources (ratio 2.22). For Jordan, Morocco, Oman and Tunisia the prices are within
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 80
a range of six from each other (ratio 7.33 to 13.6), while this price is substantially higher in
Bahrain (MSH ratio of 51.1). Bahrain had the highest retail/patient price for glibenclamide across
all national price sources. An explanation could be that it's unknown if a dispensing fee and
VAT/GST are included in this price; if included this price may appear high in comparison to retail
prices that do not include these costs. However this factor alone probably does not account for
the Bahraini price, which is more than three times the average retail/patient price (ratio 15.5)
across all national price sources.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in the SEARO region. Of the two price sources from India, only one provided
price information on glibenclamide 5mg capsules/tablets. The procurement price reported by this
source is the lowest of all the national price sources. The MSH price ratio of 0.16 shows the
Indian procurement price is only about one-sixth the international reference price.
For the WPRO region only 2 countries provide price information on medicines. Australia was the
only country reporting price information on glibenclamide 5mg capsules/tablets. Australia reported
a reimbursement price ceiling (ratio 26.7 to 33.3) leading to a high MSH price ratio. Taking the
data limitations for this price type in account it is difficult to compare this price type between
sources.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 81
Omeprazole 20mg capsules/tablets
Price information on omeprazole 20mg cap/tab is available from 37 sources, representing 35
countries. Table 25 shows a summary of the results for all these countries. All ratios mentioned in
the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for
omeprazole 20mg, which is 0.0328 US$ per capsule or tablet. For all national sources and for all
sources in the EURO region a summary table is printed below. For the other regions the
summary consists of text alone, because the number of sources was too low to establish a clear
overview in a table. But detailed tables with results for all regions can be found in the Annexes
(Annex XVIII).
Table 25: Ratio of national medicine price to MSH reference price for Omeprazole 20mg cap/tab, all national sources #1
All National price sources (n=37)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Omeprazole 20mg 0.0328 US$ per cap/tab = MSH ratio 1.00
n = 8 n = 6 n = 11 n = 12 n = 22 Median Ratio 8.69 1.33 12.5 --- 10.2 Mean Ratio 8.23 2.13 12.6 --- 11.3 Lowest Ratio 1.86 0.15 1.07 1.01 1.01 Highest Ratio 14.3 4.88 32.6 50.6 22.6 High/Low Ratio 7.7 32.0 30.6 50.3 22.4
#1 Please see section IV.4 for all data limitations;
For omeprazole 20mg, the availability of price data varied across the different price types. The
price type with the largest number of prices found was retail/patient prices (n=22), while less than
10 price points were found for ex-factory and procurement prices (n=8 and n=6, respectively).
Table 25 shows that only for the price type ex-factory the H/L ratio is below 10.0; all other H/L
ratios are much higher (ranging from 22.4 to 50.3). Meaning that large variation in price exists for
these price types. Such large variations in price cannot be justified by comparability issues alone.
Looking at procurement prices it must be noted that few price points are available (n=6). The
detailed summary table (Annex XVIII) shows that two outliers defined the high outcome of the H/L
ratio. Sudan reported the highest price (MSH ratio 4.88) the USA the second highest price (MSH
ratio 4.27), while the remaining four countries reported more comparable prices (ratios ranging
from 0.152 to 1.43). The high H/L ratio for wholesale can also be explained by the presence of
two outliers. Sweden reported the lowest wholesale price for omeprazole 20mg (MSH ratio 1.01)
and Ireland reported the highest price (ratio 32.6). The remaining nine countries reported
relatively high prices and also with great variation, but ratios ranged from 4.57 to 18.6; showing
that Sweden and Ireland can be seen as outliers. For reimbursement the high H/L ratio (50.3)
could be explained by the specific data limitations for this price type, some sources report ceiling
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 82
prices, while others report the lowest and highest reimbursed prices. Taking the data limitations
for this price type in account it is not possible to calculate a median or mean ratio for this price
type. For retail/patient prices the high H/L ratio (22.4) could also be explained by the data
limitations. Taking into account that it is not always certain whether or not VAT/GST and a
dispensing fee are included. It is expected that retail prices are higher than MSH prices, as the
latter do not include local distribution costs. The Netherlands reported the lowest price with a
MSH ratio of 1.01; Iran, Denmark and Sweden were only just above this price with price ratios of
2.10 and 2.32 (Denmark and Sweden). All other countries however, reported prices with ratios
ranging from 4.27 to 22.6; a high number of 8 countries reported prices of more than 15 times as
high as the MSH reference price.
Table 26: Ratio of national medicine price to MSH reference price for Omeprazole 20mg cap/tab, EURO region#1
WHO Region EURO (n=22)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Omeprazole 20mg 0.0328 US$ per cap/tab = MSH ratio 1.00
n = 6 n = 2 n = 9 n = 8 n = 16 Median Ratio 8.69 --- 8.54 --- 7.93 Mean Ratio 8.38 1.33 11.5 --- 10.4 Lowest Ratio 2.71 1.22 1.07 1.01 1.01 Highest Ratio 14.3 1.43 32.6 33.2 22.6 High/Low Ratio 5.3 1.2 30.6 33.0 22.4
#1 Please see section IV.4 for all data limitations;
Table 26 shows all available data for the EURO region. A total number of 22 sources,
representing 21 countries reported price information on omeprazole 20mg capsules/tablets. In all
five price categories none of the prices reported was below the MSH reference price. The lowest
prices reported for the price types wholesale, reimbursement and retail/patient in the EURO
region are also the lowest prices for all national price sources. However, the same can be said of
the highest price reported for ex-factory, wholesale and retail/patient in this region; these are also
the highest prices for all national sources. Ex-factory and procurement prices have the lowest H/L
ratio (5.3 and 1.2), meaning that this price type had the lowest amount of variation across
sources. However, for procurement only 2 price points were available for comparison, so in this
case the low H/L ratio does not tell us as much. The H/L ratios for the remaining three price types
are however much higher with values of 30.6 for wholesale, 33.0 for reimbursement and 22.4 for
retail/patient. Meaning that large variation in price exists for these three price types. Such large
variations in price cannot be justified by comparability issues alone. It must be remarked,
however that the availability of price points varies for these three price types varies (n=9, n=8 and
n=16). Although this does not influence the difference between the lowest and highest price, the
H/L ratio is a more reliable parameter when it's measured over a high number of price points.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 83
For the ex-factory price category 6 countries reported prices. The price of Hungary (ratio 14.3) is
the highest price reported in the EURO region. The prices reported by Austria and France are just
below this price (ratios 11.0 and 12.5, respectively), while the remaining three countries Lithuania,
Slovakia and Spain reported much lower prices (ratios 6.40, 3.35 and 2.71, respectively). Looking
at the income categories of the six countries it's considered remarkable that the upper-middle
income country Hungary reported the highest price. Equally remarkable is the fact that high-
income country Spain reported the second lowest ex-factory price for all national price sources
(after high income country New Zealand). The procurement prices of both Denmark and the UK
are just above the MSH reference price of 0.0328 US$, with ratios of respectively, 1.43 and 1.22.
Compared to all other national price sources reporting this price, both countries score average.
Nine countries report wholesale prices; six of them are high-income countries. Both the lowest
and the highest wholesale price in the EURO region are reported by a high-income country;
Sweden reported the lowest price (ratio 1.07) and Ireland the highest price (ratio 32.6). The two
upper-middle income countries Latvia and Lithuania report comparable prices below the average
for this region (ratios 8.54 and 6.71, respectively; mean 11.5). The third upper-middle income
Hungary reports a much higher price (ratio 15.2). Excluding outliers Sweden (very low) and
Ireland (very high), the remaining countries reported prices ranging from ratio 4.57 to 16.5. The
prices of Sweden and Ireland are also the lowest and highest price for all national price sources.
Reimbursement prices are reported by 8 countries in the EURO region. Taking the data
limitations for this price type in account it is difficult to compare this price type between sources.
All report their lowest and highest reimbursed prices, leading to a great variation in MSH price
ratios. Sixteen price sources from EURO report retail/patient prices and all of them reported
prices above the MSH reference price of 0.0328 US$. Eleven sources represent high-income
countries; the remaining five are upper-middle income countries. Both the high-income and the
upper-middle income countries display a great variation between prices. Hungary reported the
highest price in the upper-middle income class (ratio 18.6), while Slovakia reported the lowest
price in this income class (ratio 5.18). The variation between prices was even greater for the high-
income countries; France reported the highest price (ratio 22.6) and the Netherlands reported the
lowest price, which was only just above the MSH reference price (ratio 1.01). Denmark and
Sweden also reported a low price (both ratio 2.32), while all other countries within the EURO
region reported prices ranging from 4.27 to 22.6. The lowest and highest retail/patient prices
reported in this region also represent the lowest and highest price for all national price sources.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on omeprazole 20mg capsules/tablets. Both ex-factory and
wholesale price reported are above the MSH reference price of 0.0328 US$ with ratios of,
respectively 13.7 and 18.6. Looking across other countries, the South African ex-factory price is
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 84
relatively high (ratios ranging from 1.86 to 14.3). Only Hungary, also an upper-middle income
country reported a higher price (ratio 14.3). The same can be said of the wholesale price
reported; this is also high compared to all other national sources (ratios ranging from 1.07 to
32.6). And again the South African is the second highest price for all sources, this time after
Ireland (ratio 32.6)
For the AMRO region 7 sources are available, representing 3 countries. Of these sources, one
Brazilian, one Canadian and two USA websites reported price information on omeprazole 20mg
capsules/tablets. The procurement price of Brazil was below the MSH reference price with a ratio
of 0.82. The price reported by the USA was the second highest price with a high ratio of 4.27. The
price of the USA (and the highest price of Sudan, ratio 4.88) can be seen as an outlier compared
to the other procurement prices reported by national price sources (ratios ranging from 0.15 to
1.43). For reimbursement two prices were reported; one for Canada (ratio 30.8) and one for the
USA (ratio 8.23). Taking the data limitations for this price type in account it is difficult to compare
this price type between sources. Canada reports a price ceiling, leading to a high MSH price ratio
compared to the USA source and to the MSH reference price.
For the EMRO region 8 sources are available, representing 8 countries. Seven of these countries
reported price information on omeprazole 20mg capsules/tablets. All prices reported for the
countries in this region are above the MSH reference price of 0.0328 US$. For procurement
Sudan is the only country in the EMRO region reporting a price. With a ratio of 4.88 this is the
highest price for all national sources. This high price is remarkable given the fact that all other
procurement prices, which are lower, are reported by countries with a higher income than Sudan
(ratios ranging from 0.152 to 1.43 and 4.27 for USA); this shows that low-income countries like
Sudan can sometimes pay more for medicines than higher income countries. The wholesale price
of Jordan (ratio 16.5) is relatively high compared to all other national price sources (ratios ranging
from 1.07 to 18.6 and 32.6 for Ireland). It is above the mean and median ratio for all national
sources (ratios 12.6 and 12.5, respectively). The reimbursement price for Morocco is a range of
the lowest and highest reimbursed price (ratio 9.45 to 50.6), but not much can be said about this
price type because of its data limitations. Six countries in the EMRO region reported retail/patient
prices. Iran reported the second lowest retail/patient price (ratio 2.10); the prices of all remaining
five countries are about 10 to 20 times as high as the MSH reference price of 0.0328 US$.
Bahrain reports the highest price for omeprazole 20mg in the EMRO region (ratio 21.0), the
difference with the price of Jordan is however small (ratio 20.7). The other three countries report
lower prices, but all are still relatively high (Morocco 9.45, Oman 11.9 and Tunisia 17.7). The
ratios for all national price sources reporting retail/patient prices are ranging from 1.01 to 22.6.
Within this range a high number of 8 sources reports prices more than 15 times as high as the
reference price, including three sources within the EMRO region. In the retail/patient price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 85
category, the median and mean ratio of the sources in the EMRO region (14.8 and 13.8,
respectively) are higher than the median and mean ratio for all national sources (11.0 and 11.7,
respectively). Establishing that the prices reported for this price type in the EMRO region are
relatively high compared to all national price sources. An explanation for the high prices could be
that it's unknown if a dispensing fee and VAT/GST are included in the price; if included this price
may appear high in comparison to retail prices that do not include these costs. However this
factor alone probably does not account for an average price within the EMRO region that is more
than 16 times as high as the MSH reference price.
For the SEARO region two data sources for India are available. Only one of these sources
reported price information on omeprazole 20mg capsules/tablets. The procurement price reported
was the lowest price for all national sources with a MSH ratio of 0.15.
For the WPRO region New Zealand reported ex-factory price information on omeprazole 20mg
capsules/tablets. For ex-factory, this price (MSH ratio 1.86) was the lowest of all national price
sources; remarkable given the fact that a high income country thus reported a lower price than
countries with a lower income. Australia reported reimbursement price information on omeprazole
20mg capsules/tablets. Taking the data limitations for this price type in account it is difficult to
compare this price between sources. Australia reports a price ceiling (ratio 28.4-31.1) leading to a
high MSH price ratio compared to other national sources and to the MSH reference price.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 86
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 87
Salbutamol 100mcg/dose inhaler Price information on salbutamol 100mcg/dose inhalers is available from 33 sources, representing
31 countries. Table 27 shows a summary of the results for all these countries. All ratios
mentioned in the text below represent the MSH price ratio, unless otherwise stated. This MSH
price ratio is calculated by dividing the price published by the source by the MSH reference price
for salbutamol 100mcg, which is 0.0090 US$ per dose. For all national sources and for all
sources in the EURO region a summary table is printed below. For the other regions the
summary consists of text alone, because the number of sources was too low to establish a clear
overview in a table. But detailed tables with results for all regions can be found in the Annexes
(Annex XIX).
Table 27: Ratio of national medicine price to MSH reference price for Salbutamol 100mcg / dose inhaler, all national sources #1
All National price sources (n=33)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Salbutamol inhaler 100mcg 0.0090 US$ per dose = MSH ratio 1.00
n = 8 n = 4 n = 10 n = 11 n = 21 Median Ratio 1.44 1.78 1.56 --- 2.11 Mean Ratio 1.57 2.91 1.50 --- 2.33 Lowest Ratio 1.33 0.87 0.67 0.82 0.46 Highest Ratio 2.44 7.22 1.78 13.3 8.89 High/Low Ratio 1.8 8.3 2.7 16.2 19.5
#1 Please see section IV.4 for all data limitations;
For salbutamol 100mcg the availability of price data varied across the different price types. The
price type with the largest number of prices found was retail/patient prices (n=21), while few price
points were found for especially procurement (n=4). Remarkable is that in every price category,
except for ex-factory, at least one country reports a price that is lower than the MSH reference
price of 0.0090. Even more remarkable is that the retail/patient price reported in India (ratio 0.46)
is the lowest price reported in all price categories for all national price sources.
Table 27 shows H/L ratios are below 10.0 for the price types ex-factory, procurement and
wholesale; the H/L ratios of ex-factory (1.8) and wholesale prices (2.7) are even below 3.0. The
H/L ratios for reimbursement and retail/patient prices are however much higher (16.2 and 19.5,
respectively). Such large variations in price cannot be justified by comparability issues alone. For
reimbursement the high H/L ratio could be explained by the specific data limitations for this price
type, some sources report ceiling prices, while others report the lowest and highest reimbursed
prices. For retail/patient prices the high H/L ratio could also be explained by data limitations.
Taking into account that it is not always certain whether or not VAT/GST and a dispensing fee are
included. The mean ratio is only 2.50 times as high as the MSH reference price, showing that the
high H/L ratio is due to outliers. Even so, while it is expected that retail prices will be higher than
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 88
MSH prices, as the latter do not include local distribution costs, the more than 8-fold difference of
outlier Denmark is considered high.
Table 28: Ratio of national medicine price to MSH reference price for Salbutamol 100mcg / dose inhaler, EURO region#1
WHO Region EURO (n=21)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Salbutamol inhaler 100mcg 0.0090 US$ per dose = MSH ratio 1.00
n = 7 n = 2 n = 8 n = 8 n = 15 Median Ratio 1.44 --- 1.56 --- 2.33 Mean Ratio 1.62 4.04 1.58 --- 2.93 Lowest Ratio 1.44 0.87 1.44 0.82 0.82 Highest Ratio 2.44 7.22 1.78 13.3 8.89 High/Low Ratio 1.7 8.3 1.2 16.2 10.8
#1 Please see section IV.4 for all data limitations;
Table 28 shows all available data for countries in the EURO region. A total number of 21 sources,
representing 19 countries reported price information on salbutamol 100mcg/dose inhalers. The
lowest MSH ratios for procurement, reimbursement and retail/patient are below the MSH
reference price (ratios 0.87, 0.82 and 0.82, respectively). The lowest ratios reported by countries
in the EURO region for procurement and reimbursement are also the lowest ratios for all national
sources. However, the highest ratios reported in every price category by countries in the EURO
region are also the highest ratios for all national sources. Ex-factory and wholesale prices have
low H/L ratios below 2.0, meaning that these price types had little variation across sources. The
availability of data was not high in both categories (ex-factory n=7 and wholesale n=8), but high
enough to make a fair comparison to the other price categories. For the ex-factory price category
7 countries reported prices. All countries report prices above the MSH reference price, however
they all are relatively low and there is little variation across sources (ratios ranging from 1.44 to
2.44). Austria, Czech Republic, Slovenia and Spain report the exact same price (ratio 1.44); the
same can be said of Lithuania and Slovakia (ratio 1.56). The procurement price of the UK is
below the MSH reference price of 0.0090 US$, but the price reported by Denmark is much higher
than this reference price (ratios 0.87 and 7.22, respectively). The Danish price is the highest of all
national price sources, while the UK price is the lowest price for all national price sources. Eight
countries report wholesale prices and the variation between the prices reported is very low given
the H/L ratio of 1.2 (ratios ranging from 1.44 to 1.78). The highest price reported by Norway is
also the highest for all national price sources; however this price is still regarded low with a MSH
ratio of only 1.78. Reimbursement prices are reported by 7 countries in the EURO region. Taking
the data limitations for this price type in account it is difficult to compare this price type between
sources. All report their lowest and highest reimbursed prices, leading to a great variation in MSH
price ratios. Remarkable is that two sources for the UK report different reimbursed amounts. The
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 89
Drug Tariff for Scotland reimburses 0.011 US$ (MSH ratio 1.22) per dose, while the Drug Tariff
for England and Wales reimburses 0.026 US$ (MSH ratio 2.89) per dose. Fifteen price sources
from EURO report retail/patient prices, of them only the Netherlands reports a price below the
MSH reference price of 0.0090 US$. This is remarkable given the fact that MSH prices do not
include local distribution costs, while retail/patient prices are at the end of the distribution chain
and thus include mark-up costs. The prices of the four upper-middle income countries Hungary,
Latvia, Lithuania and Slovakia are just above the MSH reference prices with ratios of 1.56, 1.56,
1.67 and 1.67, respectively. Denmark reports the highest price (ratio 8.89), which is also the
highest price for all national price sources. Poland report the second highest price in the EURO
region (ratio 5.22), this is unexpected for an upper-middle income country. Both Denmark and
Poland can be seen as outliers given the fact that the remaining 13 sources, both upper-middle
and high-income countries, report much lower prices (ratios ranging from 0.82 to 3.78). On
average the prices are about 3 times as high as the MSH reference price (mean ratio 2.93 and
median ratio 2.33). These high ratios could be partially explained by the fact that MSH prices do
not include local distribution costs, but this alone probably does not account for differences above
the mean ratio.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on salbutamol 100mcg/dose inhalers. Both ex-factory and
wholesale price reported are above the MSH reference price of 0.0090 US$ with ratios of,
respectively 1.44 and 1.67. But both are below the median and mean in their own price
categories for all national sources. Thus, while the prices are above the MSH price, they are not
particularly high compared to all other national sources. Looking across other upper-middle
income countries, South African prices are the lowest for ex-factory and average for wholesale.
For the AMRO region 7 sources are available, representing 3 countries. Only the Brazilian and
one Canadian website reported price information on salbutamol 100mcg/dose inhalers. The
procurement price for Brazil is above the MSH reference price with a ratio of 1.44. This is
however below both the median and the mean ratio for all national sources in this price type
(ratios 1.78 and 2.91, respectively). Thus, while the price is above the MSH price, it is not
particularly high compared to all other national sources. For reimbursement Canada reports a
MSH ratio of 3.22. Taking the data limitations for this price type in account it is difficult to compare
this price type between sources. Keeping in mind that Canada reports a price ceiling, its
reimbursement price is very low.
For the EMRO region 8 sources are available, representing 8 countries. Six countries reported
price information on salbutamol 100mcg/dose inhalers. Two countries, Jordan and Oman, stayed
below the MSH reference price and were the lowest ones in their price categories (wholesale and
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 90
retail/patient, respectively). For procurement Sudan is the only country in the EMRO region
reporting a price. With a ratio of 2.11 this price was below the average price (ratio 2.91) for all
national sources in this category. It is the second highest price for all national sources and apart
from Denmark (ratio 7.22) the two other countries stay below Sudan's price, although they have a
higher income (Brazil ratio 1.44 and UK ratio 0.87). The wholesale price of Jordan (ratio 0.67) is
the lowest one in its price category compared to all other national price sources. The
reimbursement price for Morocco is a range of the lowest and highest reimbursed price (ratio 2.56
to 3.56), but not much can be said about this price type because of its data limitations. Five
countries in the EMRO region reported retail/patient prices. For Jordan and Oman the prices are
below the MSH reference price of 0.0090 US$ (ratios 0.84 and 0.46, respectively); the price
reported by Jordan is the lowest one found for all the national price sources. The price reported
by Iran represented the median retail/patient price in the EMRO region (ratio 1.44). Morocco and
Bahrain reported comparable, slightly higher prices with ratios of 2.67 and 2.56, respectively. This
is however somewhat remarkable given the fact that Morocco is a lower-middle income country
while Bahrain is a high-income country. Meaning that it would be expected the prices are more
apart (Morocco lower than Bahrain). An explanation could be that it's not always clear if a
dispensing fee and VAT/GST are included in this price; if included this price may appear high in
comparison to retail prices that do not include these costs.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in the SEARO region. Of the two price sources from India, only one provided
price information on salbutamol 100mcg/dose inhalers. The retail/patient price reported by this
source is not the lowest of all the national price sources, but it is below the MSH reference price
of 0.0090. Further, it must be noted that the retail/patient price reported in India (ratio 0.46) is the
lowest price reported for all price categories with all national price sources. This is remarkable
given the fact that it's a ceiling price, the maximum price allowed to be paid for this medicine.
For the WPRO region only 2 countries provide price information on medicines. New Zealand
reported ex-factory price information, while Australia reported reimbursement price information on
salbutamol 100mcg/dose inhalers. For ex-factory, New Zealand reported the lowest price of all
national sources with a MSH price ratio of 1.33. It must be noted that the prices reported by the
other 7 countries were not much higher (ratios ranging from 1.44 to 2.44). Taking the data
limitations for reimbursement prices into account it is difficult to compare this price type between
sources. Australia reports a price ceiling (ratio 8.33 to 10.2) leading to a high MSH price ratio
compared to other national price sources and to the MSH reference price.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 91
Simvastatin 20mg capsules/tablets
Price information on simvastatin 20mg cap/tab is available from 37 sources, representing 34
countries. Table 29 shows a summary of the results for all these countries. All ratios mentioned in
the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is
calculated by dividing the price published by the source by the MSH reference price for
simvastatin 20mg, which is 0.0629 US$ per capsule or tablet. For all national sources and for all
sources in the EURO region a summary table is printed below. For the other regions the
summary consists of text alone, because the number of sources was too low to establish a clear
overview in a table. But detailed tables with results for all regions can be found in the Annexes
(Annex XX).
Table 29: Ratio of national medicine price to MSH reference price for Simvastatin 20mg cap/tab, all national sources #1
All National price sources (n=37)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Simvastatin 20mg 0.0629 US$ per cap/tab = MSH ratio 1.00
n = 8 n = 5 n = 10 n = 13 n = 22 Median Ratio 2.94 0.45 4.21 --- 4.77 Mean Ratio 2.84 0.57 4.52 --- 4.65 Lowest Ratio 0.38 0.091 0.22 0.24 0.24 Highest Ratio 5.88 1.11 14.9 16.2 8.90 High/Low Ratio 15.4 12.3 67.1 68.0 37.3
#1 Please see section IV.4 for all data limitations;
For simvastatin 20mg, the availability of price data varied across the different price types. The
price type with the largest number of prices found was retail/patient prices (n=22), while less than
10 price points were found for ex-factory and procurement prices (n=8 and n=5, respectively).
Table 29 shows that the H/L ratio is above 10.0 for all price types. The H/L ratio of procurement is
just above 10.0 (H/L ratio 12.3), while the ratios of the remaining three price types are much
higher. In particular the H/L ratios for wholesale and reimbursement are high (67.1 and 68.0,
respectively); the H/L ratio for retail/patient is 37.3 and thus high as well. Meaning that large
variation in price exists for these three price types. Such large variations in price cannot be
justified by comparability issues alone. Looking at wholesale it must be noted that few price points
are available. The detailed summary table (Annex XX) shows that four out of the five countries
report prices below the MSH reference price of 0.0629 US$ (ratios ranging from 0.091 to 0.95).
The highest price in this price category is reported by Sudan, but is still low with a MSH ratio of
1.11. For reimbursement the high H/L ratio could be explained by the specific data limitations for
this price type, some sources report ceiling prices, while others report the lowest and highest
reimbursed prices. Taking the data limitations for this price type in account it is not possible to
calculate a median or mean ratio for this price type. For retail/patient prices the high H/L ratio
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 92
(37.3) could also be explained by the data limitations. Taking into account that it is not always
certain whether or not VAT/GST and a dispensing fee are included. It is expected that retail
prices are higher than MSH prices, as the latter do not include local distribution costs. However,
the large variation between the prices suggests that this does not account for the differences
alone.
Table 30: Ratio of national medicine price to MSH reference price for Simvastatin 20mg cap/tab, EURO region#1
WHO Region EURO (n=22)
Ex-factory / Manufacturer price
Procurement price
Wholesale price
Reimburse-ment price
Retail / Patient price
MSH ref. price (2008)
Simvastatin 20mg 0.0629 US$ per cap/tab = MSH ratio 1.00
n = 6 n = 2 n = 9 n = 8 n = 16 Median Ratio 3.66 --- 4.29 --- 3.90 Mean Ratio 3.46 0.17 4.49 --- 4.00 Lowest Ratio 1.49 0.091 0.22 0.24 0.24 Highest Ratio 5.88 0.24 14.9 10.3 8.11 High/Low Ratio 3.9 2.6 67.1 43.3 34.0
#1 Please see section IV.4 for all data limitations;
Table 30 shows all available data for the EURO region. A total number of 22 sources,
representing 21 countries reported price information on simvastatin 20mg capsules/tablets. In
four price categories one or more prices below the MSH reference price were reported. The
lowest prices of every price type, except for ex-factory, reported in the EURO region are also the
lowest prices for all national price sources. The highest prices reported in this region for ex-
factory and wholesale are also the highest prices for all national price sources. Ex-factory and
procurement prices have the lowest H/L ratio (3.9 and 2.6), meaning that this price type had the
lowest amount of variation across sources. However, for procurement only 2 price points were
available for comparison, so in this case the low H/L ratio does not tell us as much. The H/L ratios
for the remaining three price types are however much higher with values of 67.1 for wholesale,
43.3 for reimbursement and 34.0 for retail/patient. Meaning that large variation in price exists for
these three price types. Such large variations in price cannot be justified by comparability issues
alone. It must be remarked, however that the availability of price points varies for these three
price types varies (n=9, n=8 and n=16). Although this does not influence the difference between
the lowest and highest price, the H/L ratio is a more reliable parameter when it's measured over a
high number of price points.
For the ex-factory price category 6 countries reported prices. The price of France (ratio 5.88) is
the highest price reported in the EURO region. The prices reported by Austria, Hungary and
Lithuania are comparable with ratios of 3.66, 3.66 and 3.82, respectively. The price of France is
also the highest for all national sources, while the prices of Austria, Hungary and Lithuania are
also considered relatively high since they are above the median and mean price for all national
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 93
price sources (mean ratio 2.84 and median ratio 2.94). The procurement prices of both Denmark
and the UK are below the MSH reference price of 0.0629 US$. The Danish price is the lowest of
all national price sources with a ratio of 0.091, while the UK price is the second lowest price of all
national price sources (ratio 0.24).
Eight countries report wholesale prices, 6 of them are high-income countries. The two upper-
middle income countries Latvia and Lithuania report very different prices with ratios of 1.91 and
4.13, respectively. The price of Latvia is relatively low in comparison to the other national
sources, the Lithuanian price is however considered high, especially given the income level. The
six high-income also report prices with a great variation (ratios ranging from 0.22 to 14.9); a high
outlier is Ireland with a price almost 15 times as high as the reference price. Finland and Sweden
report prices of about one-fourth the MSH reference price (ratios 0.22 and 0.25, respectively).
Both the lowest and the highest price reported for countries in EURO region are also the lowest
and highest price for all national price sources (ratios 0.22 and 14.9). Reimbursement prices are
reported by 8 countries in the EURO region. Taking the data limitations for this price type in
account it is difficult to compare this price type between sources. All report their lowest and
highest reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources
from EURO report retail/patient prices, thirteen of them have prices higher than the MSH
reference price of 0.0629 US$. Eleven sources represent high-income countries; the remaining
five are upper-middle income countries. The upper-middle income countries all report prices
above the MSH reference price (ratios ranging from 2.54 to 4.93). All prices reported by the high-
income countries display a greater variation (ratios ranging from 0.24 to 8.11). All high ratios
could be partially explained by the fact that MSH prices do not include local distribution costs.
However, Denmark, Finland and the Netherlands all report prices below the MSH reference price
(ratios 0.72, 0.43 and 0.24, respectively). This is remarkable given the fact that MSH prices do
not include local distribution costs, while retail/patient prices are at the end of the distribution
chain and thus include mark-up costs.
For the AFRO region three data sources for South Africa are available; no other price sources
were found for countries in the AFRO region. Of the three price sources from South Africa, only
one provided actual price information on simvastatin 20mg capsules/tablets. Both ex-factory and
wholesale price reported are above the MSH reference price of 0.0372 US$ with ratios of,
respectively 1.59 and 2.23. Looking across other upper-middle income countries, the South
African ex-factory price is low (ratios ranging from 2.23 to 3.82). The same can be said of the
wholesale price reported compared to all other national sources in the same income group (ratios
ranging from 1.91 to 4.29).
For the AMRO region 7 sources are available, representing 3 countries. Of these sources, one
Brazilian, one Canadian and three USA websites reported price information on simvastatin 20mg
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 94
capsules/tablets. The procurement prices for both Brazil and USA were below the MSH reference
price with ratios of, respectively 0.45 and 0.95. Both prices score just below average in their price
category with all national price sources. For reimbursement 3 prices were reported, one for
Canada (ratio 15.9) and two for the USA (ratio 2.70 and 3.34). Taking the data limitations for this
price type in account it is difficult to compare this price type between sources. Canada reports a
price ceiling, leading to a high MSH price ratio compared to the USA source and to the MSH
reference price.
For the EMRO region 8 sources are available, representing 8 countries. Seven of these countries
reported price information on simvastatin 20mg capsules/tablets. All prices reported for the
countries in this region are above the MSH reference price of 0.0629 US$. For procurement
Sudan is the only country in the EMRO region reporting a price. With a ratio of 1.11 this is the
highest price for all national sources. Although this price is only just above the MSH reference
price it is considered high for a low-income country. Especially given the fact that all other
procurement prices reported are below the MSH price, while they have a higher income than
Sudan (ratios ranging from 0.091 to 0.95); this shows that low-income countries like Sudan can
sometimes pay more for medicines than higher income countries. The wholesale price of Jordan
(ratio 7.15) is the second highest price for all national price sources in this category (Ireland ratio
14.9). This is unexpected because all other countries reporting a lower price for wholesale have a
higher income than Jordan (ratios ranging from 0.22 to 5.72). The reimbursement price for
Morocco is a range of the lowest and highest reimbursed price (ratio 5.25 to 10.9), but not much
can be said about this price type because of its data limitations. Six countries in the EMRO region
reported retail/patient prices. Iran reported the lowest retail/patient price in the EMRO region
(ratio 1.59). The prices of all other five countries are at least 5 times as high as the MSH
reference price of 0.0629 US$. Jordan reports the highest price for simvastatin 20mg in the
EMRO region (ratio 8.90), the difference with the prices of Lebanon and Oman is however small
(ratio 8.74 and 8.59, respectively). Although the difference is small, it is remarkable that lower-
middle income country Jordan has a higher price than upper-middle income countries Lebanon
and Oman. The other two lower-middle income countries Morocco and Tunisia have lower prices,
although the differences are still small (ratios 5.25 and 7.47, respectively). Compared to all
national price sources, the prices in the EMRO region are (relatively) high; all but the Iranian price
are above the median and mean ratio for all sources (ratios 3.90 and 4.00, respectively). The
prices of Jordan, Lebanon and Oman are also the three highest prices for all national price
sources.
For the SEARO region two data sources for India are available; no other price sources were
found for countries in the SEARO region. None of these sources reported price information on
simvastatin 20mg capsules/tablets.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 95
For the WPRO region only 2 countries provide price information on medicines. For ex-factory,
only New Zealand reported a price below the MSH reference price which was thus also the
lowest ex-factory price of all national sources. The MSH price ratio of 0.38 showed that this price
is only about one-third the international reference price. Australia reported reimbursement price
information on simvastatin 20mg capsules/tablets. Taking the data limitations for this price type in
account it is difficult to compare this price type between sources. Australia reports a price ceiling
(ratio 16.2) leading to a high MSH price ratio compared to the other national price sources and to
the MSH reference price.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 96
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 97
Comparison of therapeutic equivalent substances
In addition to comparing the prices of the same medicine across websites, a comparative analysis
between selected therapeutic equivalent pharmaceutical substances was also carried out. The
aim of this comparison was to investigate the extent of the price variance for medicines which
have the same therapeutic effect. Two well-known branded medicines were compared to generic
therapeutically equivalent medicines. Atorvastatin 20mg, which is manufactured by Pfizer under
the names Lipitor, Sortis, Tahor, Torvast and others, was compared to its therapeutic equivalent
simvastatin 20mg. And esomeprazole 20mg, which is manufactured by AstraZeneca under the
names Nexium, Nexium, Inexium and others, was compared to its therapeutic and pharmacologic
equivalent omeprazole 20mg.
Atorvastatin 20mg vs. Simvastatin 20mg
Atorvastatin and simvastatin are considered to be therapeutically equivalent; meaning that both
medicines can be replaced by one-and-other without any change in therapeutic effect. However,
despite this equivalence, many patients are still on a daily prescription of atorvastatin, which is
still under patent and is usually more expensive. Atorvastatin is produced by Pfizer under the
brand names Lipitor, Sortis, Tahor and Torvast. The price comparison was limited to these
products for all price types except retail/patient prices, where the prices of INN generics were also
collected to highlight the importance of generic substitution.
Price information on atorvastatin 20mg cap/tab was available for 25countries. Because most non-
profit suppliers supply the cheaper simvastatin the generic market for atorvastatin is still very
small and therefore a MSH reference price is not (yet) available. To enable the comparison of
prices across different sources, the price of simvastatin was used as a reference. Rather than to
calculate an average price or median price per price type for simvastatin, it was decided to report
the price of simvastatin per individual country to show the actual price difference between
atorvastatin and simvastatin. Prices of simvastatin had previously been collected for the price
comparison across websites and thus were readily available for each of the 25countries.
All ratios mentioned in the text below represent the country price ratio of atorvastatin compared to
simvastatin, unless otherwise stated. This ratio is calculated by dividing the published price for
atorvastatin by the price of simvastatin in the same country. No country price ratios were
calculated for reimbursement prices due to the difficulties in comparing these prices. For
example, reimbursement prices are sometimes presented as a price ceiling (maximum
reimbursed amount), while in other cases countries report their lowest and highest
reimbursement level dependent on the brand chosen.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 98
Summary results for the price comparison between atorvastatin 20mg cap/tab and simvastatin
20mg cap/tab are shown in Table 31. A detailed version of the table, with ratios for individual
national sources, can be found in the Annexes (Annex XXI).
Table 31: Price ratio of branded Atorvastatin 20mg cap/tab compared to generic Simvastatin 20mg cap/tab per country #1 (Pfizer brands: Lipitor, Sortis, Tahor and Torvast)
All National price sources (n=25)
Ex-factory / Manufacturer price Pfizer vs Generic
Procurement price Pfizer vs Generic
Wholesale price Pfizer vs Generic
Retail / Patient price Pfizer vs Generic
Retail / Patient price Generic vs Generic
MSH ref. price (2008)
No MSH reference price available: reference is country price Simvastatin 20mg Country price ratio = (Country price ATV/Country price SMV)
n = 5 n = 2 n = 10 n = 18 n = 11 Median Ratio 6.48 --- 5.56 5.66 1.98 Mean Ratio 7.64 129.8 20.4 14.8 3.16 Lowest Ratio 4.58 45.5 1.95 2.79 1.26 Highest Ratio 10.8 214.0 103.8 90.0 15.2 High/Low Ratio 2.4 4.7 53.2 32.3 12.1
#1 Please see section IV.4 for all data limitations;; ATV=atorvastatin; SMV=simvastatin;
For atorvastatin 20mg, the availability of price data varied across the different price types. The
price type with the largest number of prices found was retail/patient prices. For the originator
Pfizer brands (Lipitor, Sortis, Tahor and Torvast) 18 retail/patient prices were found, while less
than 10 price points were found for ex-factory and procurement prices (n=5 and n=2,
respectively). The high/low (H/L) ratio is an important parameter, as it shows the variation in
prices across sources. However comparability issues must be taken into account, for example
some prices include VAT while others do not. Table 31 shows that for ex-factory and procurement
prices, the H/L ratio is below 10.0 (2.4 and 4.7, respectively). The H/L ratio of generic
retail/patient prices is just above 10.0 (H/L ratio 12.1), while the H/L ratios of wholesale and Pfizer
brand retail/patient prices are much higher (53.2 and 32.3, respectively). These high H/L ratios
mean a large variation in price exists for these price types. However, given the fact that
comparisons are not with a constant but with a fluctuating simvastatin price it is more difficult to
judge the high or low value of the calculated mean, median and H/L ratios.
For retail/patient prices, price ratios were compared between the originator brand and generic
simvastatin, and between generic atorvastatin and generic simvastatin. A substantial difference in
retail/patient prices between the Pfizer brands and generic products was observed. Namely, the
median and mean value of the generics (ratios 1.98 and 3.16, respectively) are substantially
lower than the median and mean of the Pfizer brands (ratios 5.66 and 14.8, respectively). This
shows that generic substitution is important and can lead to lower prices for patients. Large
high/low ratios observed for both the brand and generic products show that in some countries the
prices of atorvastatin and simvastatin are closer than in others. However low ratios may not be
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 99
the result of low atorvastatin prices but rather of high simvastatin prices, and as such may not
always be desirable.
Esomeprazole 20mg vs. Omeprazole 20mg
Esomeprazole and omeprazole are considered therapeutically and pharmacologically equivalent;
meaning that both medicines can be replaced by one-and-other without any change in
therapeutic effect. Esomeprazole is produced by AstraZeneca under the brand names Nexium,
Nexiam and Inexium. The price comparison was limited to these products for all price types.
Price information on esomeprazole 20mg cap/tab was available for 21 countries. Because there
is no generic market for esomeprazole (yet), a MSH reference price is not available. To enable
the comparison of prices across different sources, the price of omeprazole was used as a
reference. Rather than to calculate an average price or median price per price type for
omeprazole, it was decided to report the actual price of omeprazole per individual country to
show the actual price difference between esomeprazole and omeprazole. Prices of omeprazole
had previously been collected for the price comparison across websites and thus were readily
available for each of the 21 countries. All ratios mentioned in the text below represent the country
price ratio of esomeprazole compared to omeprazole, unless otherwise stated. This ratio is
calculated by dividing the published price for esomeprazole by the price of omeprazole in the
same country. No country price ratios were calculated for reimbursement prices due to the
difficulties in comparing these prices. For example, reimbursement prices are sometimes
presented as a price ceiling (maximum reimbursed amount), while in other cases countries report
their lowest and highest reimbursement level dependent on the brand chosen.
Summary results for the price comparison between esomeprazole 20mg cap/tab and omeprazole
20mg cap/tab are shown in Table 32. A detailed version of the table, with ratios for individual
national sources, can be found in the Annexes (Annex XXII).
Table 32: Price ratio of branded Esomeprazole 20mg cap/tab compared to generic Omeprazole 20mg cap/tab per country #1 (Astra Zeneca brands: Nexium, Nexiam and Inexium)
All National price sources (n=24)
Ex-factory price AstraZeneca vs Generic
Procurement price AstraZeneca vs Generic
Wholesale price AstraZeneca vs Generic
Retail / Patient price AstraZeneca vs Generic
MSH ref. price (2008)
No MSH reference price available: reference is country price Omeprazole 20mg; Country price ratio = (Country price EMP/Country price OMP)
n = 5 n = 3 n = 9 n = 18 Median Ratio 2.92 14.1 2.33 4.36 Mean Ratio 5.96 15.9 6.89 7.19 Lowest Ratio 1.72 4.56 1.32 1.64 Highest Ratio 12.1 28.9 41.1 26.7 High/Low Ratio 7.0 6.3 31.1 16.3
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 100
#1 Please see section IV.4 for all data limitations; EMP=esomeprazole; OMP=omeprazole;
For esomeprazole 20mg, the availability of price data varied across the different price types. The
largest number of prices was found for retail/patient prices (n=18), while less than 10 price points
were found for the remaining price types ex-factory, procurement and wholesale prices (n=5, n=3
and n=9, respectively). The high/low (H/L) ratio is an important parameter, as it shows the
variation in prices across sources. However, comparability issues must be taken into account, for
example some prices include VAT while others do not. Table 32 shows that for ex-factory and
procurement prices, the H/L ratio is below 10.0 (7.0 and 6.3, respectively). The H/L ratios of
retail/patient and wholesale prices are much higher with H/L ratios of 31.1 and 16.3, respectively.
These high H/L ratios mean a large variation in price exists for these price types. However, given
the fact that comparisons are not with a constant but with a fluctuating omeprazole price it is more
difficult to judge the high or low value of the calculated mean, median and H/L ratios.
Despite this limitation, the large high/low ratios observed show that in some countries the prices
of esomeprazole and omeprazole are closer than in others. However, low ratios may not be the
result of low esomeprazole prices but rather of high omeprazole prices, and as such may not
always be desirable.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 101
VI - DISCUSSION In recent years many types of medicine price information have become available on websites.
However, both the quality of these websites, and the availability of descriptive information about
the prices to allow appropriate interpretation, can limit their usefulness. We therefore conducted
an evaluation of 71 websites reporting medicine prices. The evaluation of medicine pricing
websites needs specific criteria to assess both the quality of the site in general, and the quality of
the price data reported. This is of importance because the general quality of a website may not be
an indication of the quality of the price information. Most pricing websites are not created for the
purpose of price comparisons, but rather to share information with national organizations,
healthcare professionals such as dispensers and the public. However, these websites are being
used for international price comparisons even though that is not their initial objective. When
assessing websites, comprehensiveness of information should therefore be a key criterion
regardless of the source of the website and its initial objective.
Web based searches were conducted to identify national and international websites for the
comparative analysis. Most of the identified websites were available on a detailed list developed
by Health Action International (HAI) and could easily be accessed through their medicine price
website. Some very useful international websites, like the Price Information Exchange for the
Western Pacific Region (http://piemeds.com/), could unfortunately not be included in the present
analysis because they became available online after the closing date of the qualitative analysis.
After finishing both the qualitative and quantitative analysis of each website, the complete report
was send out for external review. This resulted in the identification of additional websites and/or
price types for Belgium, the Czech Republic, the United Kingdom and Health Action International
(HAI). These additions, identified after analysis by the source, are mentioned in the qualitative
analysis, however they could not be included in the quantitative analysis as it would not be fair to
compare prices of different price dates.
General site quality
The results of the qualitative analysis showed great variation across websites in terms of layout
and design of the price database, however most websites received the highest score (2) for user-
friendliness. Conversely, many websites received a low score for update of site and price
information. Most websites failed to publish the date on which the general website and/or the
price information was last updated, resulting in overall low scores on this criterion. The availability
of a site map, search ability within the price information and the availability of both a download
and print version of the price information were other important elements that could frequently be
improved. Some sites required registration prior to gaining access to price data. In Jordan for
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 102
example, price information is only available to patients after registration to make sure they are
always provided with the most up-to-date information (email-updates), while Lebanon only
provides additional price information to healthcare professionals following registration. The great
variation observed across sites with respect to layout and the overall availability of (additional)
price information could partially be explained by cultural difference between countries (e.g.
privacy issues, personal patient accounts (Bahrain)), but the starting point of the analysis could
affect the scoring as well (Jordan, HAI). The homepage of the price reporting website or price
database was chosen as the starting point. However, when using this hyperlink it is not always
possible to access the general homepage of the country or organization.
A limitation of the present study was that no validated tool was available to conduct the qualitative
analysis; a template was therefore developed to assess the pricing websites. The scoring system
was prone to subjectivity to some extent; the three point scoring scale proved to be difficult to
implement for all websites, despite a clear description for each score. To minimize subjectivity, 2
other authors were consulted when scoring was questionable. Overall, the evaluation template
appeared to be a useful tool for investigating websites reporting medicine prices in a consistent
manner.
Another factor that could have influenced the scores is the date and time at which the website
was reviewed. For example, a website with regular updating may have received a higher or lower
score on date of last update depending on the day on which the site was accessed. Because it is
impossible to keep up with the updates of the 50 national and 20 international websites that were
reviewed, the date on which the website was accessed is listed above the table that provides the
individual scores for each website (Annex IV to XIII).
Quality of price information
The national and international websites included in the review reported various types of medicine
prices: ex-factory, procurement, wholesale, reimbursement and retail/patient prices. To improve
the interpretability of the price data it is recommended that websites publish information on the
components of each price, for example whether VAT/GST is included or not and if so, the amount
of the tax. A specific checklist for every price type was designed to assess the
comprehensiveness of the price information. The scoring was based on a simple yes or no
answer based on availability of specific information, as well as not applicable when the criterion
was not valid for the website (e.g. exchange rate if prices were reported in country’s local
currency). In addition, for some criteria specifications were listed (e.g. which INCO term, value of
VAT/GST, etc). Although this scoring system seems straightforward and easy to implement,
difficulties did occur during the assessment. The answer no (i.e. information not available) proved
to be more difficult, as information may in fact be available but may be difficult to find (e.g.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 103
available on different section of website). It was therefore decided to list no if the additional
information was not found in either the price database or by scrolling the medicine prices section
of the website. In this way the quality of the price information could be assessed in a consistent
manner. In addition, website users would probably have similar difficulties in finding information
that was not readily available, justifying a low score.
One additional remark on the qualitative analysis is the relative importance of the awarded
scores. It is difficult to assess what is more important: the site in general or the quality of the price
information reported. Because this depends a great deal on the objective of the user, there is no
easy answer for this question. One could also argue that the user-friendliness of the general site
is important to be able to properly interpret the available price information. Therefore the quality of
both the general site and the price information were considered equally important.
Comparability of prices: issues encountered
A lack of comparability of price data across sites limits the usefulness of price comparisons. In the
quantitative analysis, data was adjusted where possible to improve the comparability of price data
reported from different sources. In some cases websites included sufficient information to allow
such adjustments, for example the value of taxes (VAT/GST) included in retail/patient prices.
However in other cases, such as for reimbursement prices, price comparisons were more difficult.
Overall, the websites generally did not provide all the qualitative (additional) price information
desired to perform international price comparisons, which was a key limitation of the quantitative
analysis.
The exchange rate is an uncertain variable that could also have influenced the variation in price
observed in the quantitative analysis. Prices were rarely reported in American dollars (US$), but
rather in the country’s local currency or in Euros (€). Because none of the websites listed an
exchange rate on their website, these rates were calculated according to the date of price
information. Clear information on the date of the price information was, however, not available on
every website. It is therefore recommended that websites mention the exchange rate on their
website to improve international price comparisons.
For ex-factory and procurement prices, websites did not include information on the INCO term of
reported prices. It was therefore not possible to adjust for this factor, which might have
contributed to the observed price variations between sources. Another issue with ex-factory
prices was that it was not always clear whether actual sale prices or indicative prices were
reported. The comparison of procurement prices was complicated by the way in which prices
were reported. On some websites it was clear that a discount was given for larger pack sizes,
while on others only the price per tablet was reported. The latter could be the lowest (discount)
price, but could also be a mean price over the course of a year.
For wholesale prices it was not always clear if logistic fees and taxes were included, and the
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 104
issue of discounts on larger pack sizes or a price per tablet is also applicable for this price type.
For both reimbursement and retail/patient prices, several sources did not specify whether a
dispensing fee and/or VAT/GST were included. Another issue was co-payments, which often
depend on the brand chosen (even differences between INN generics) and for some countries
(e.g. Australia, Portugal, United States), on the patient status and his/her insurance level.
Variations in the way in which reimbursement prices were reported were a further limitation. Most
countries reported a reimbursed amount based on the brand chosen, while others reported the
lowest and highest amounts reimbursed or a price ceiling, which represents the maximum
amount reimbursed for a medicine. This resulted in a large variation in prices, making it difficult to
include reimbursement prices in international price comparisons. Retail/patient prices were also
limited by variations in the way in which they were reported. Some sources published the prices
of several INN generics, while others only reported an average price for the medicine. If multiple
prices were available, the lowest price was selected for comparison, even though this is not
always fair when comparing to other sources with a lower availability of price points. Moreover,
the lowest price sometimes corresponds to a large pack size (up to 500 tablets), when these
would never be sold to a patient. However, the biggest limitation in the comparison of
retail/patient prices relates to the dispensing fee on medicines. Many developed countries charge
a fixed dispensing fee on medicines irrespective of the amount dispensed. Depending on the
price and the quantity of the medicine, this charge might be a significant contributor to the final
patient price, but it is frequently not reported.
International price comparisons
A quantitative analysis of medicine prices found on national websites was conducted to assess
the feasibility of comparing web-based medicine price information from different sources. The
analysis was performed on the prices of 7 medicines selected for their wide range of therapeutic
effects and the expected high availability of price data. These seven were: the tricyclic
antidepressant amitriptyline 25mg cap/tab, the selective beta-blocker (ß1-receptor) atenolol 50mg
cap/tab, the antibiotic ciprofloxacin 500mg cap/tab, the anti-diabetic glibenclamide 5mg cap/tab,
the proton pomp inhibitor omeprazole 20mg cap/tab, the ß2-receptor sympatheticomimetic
salbutamol 100mcg/dose inhaler and the statin simvastatin 20mg cap/tab. Only INN generics
were included in this research in order to keep the comparison of prices as consistent as
possible; prices of INN generics proved to be more comparable across countries. However, large
variations were still found in the prices of individual medicines; this variation was often greatest
for procurement, reimbursement and retail/patient prices. While some price variation would be
expected due to comparability issues, these and other national issues alone would not account
for the large scale price variations that were found. As such it can be concluded that prices for the
same products vary widely across countries, even within one region. It could be argued that
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 105
choosing other medicines would have led to different results, but a similar outcome is more likely,
especially given the fact that most countries occupied the same position (low/average/high price)
for every medicine, compared to all other national price sources. For example, the Austrian prices
for ex-factory, wholesale and retail were high for all selected medicines, while the Netherlands
was the only country reporting a retail price below the MSH reference price for both simvastatin
and salbutamol, and a retail price equal to the MSH reference price for omeprazole. The prices of
the Scandinavian countries - Finland, Norway and Sweden - varied but were generally low. The
prices of countries within the EMRO region were generally high, even though their income level
was lower than most countries in, for example, the EURO region. The ex-factory prices of New
Zealand were considered low for six out of the seven selected medicines (no price reported for
glibenclamide 5mg).The procurement and retail/patient prices of India were also low for all
selected medicines, whereas all reported South African prices were close to the mean.
Although results were not grouped according to their World Bank Country Income Category, it
was taken into account by comparing countries not only regionally (that is by WHO Region), but
by also comparing them to other countries in their respective income class. Surprisingly, lower
income countries reported higher prices than higher income countries on more than one
occasion. For Hungary this was the case for all medicines except atenolol 50mg cap/tab. For
Jordan and Sudan, this was even the case for each of the prices they reported. Because the
incomes of countries are different, there is a different meaning to low and high prices. While it
may not influence the availability of medicine in a higher income country, a high price in a lower
income country has a greater influence on the availability of the selected medicines because their
Purchasing Power Parity (PPP) is lower. Moreover, in high income countries more funding
options (e.g. health insurance) are available to pay for a higher-priced medicine; the negative
impact of a high price is thus greater for lower income countries.
It was clearly visible that a strong local manufacturing sector for the selected medicines strongly
influenced their prices. For example both India (procurement and retail) and Iran (retail) reported
low prices for all medicines analysed.
While only a few countries reported more than two price types per medicine, differences in mark-
up costs within the distribution chain (ex-factory to retail price) were noticeable. For ciprofloxacin,
for example, Austria (reporting ex-factory, wholesale, retail) and France (reporting ex-factory,
reimbursement, retail) published high prices in each of the categories and the price differences
between the price types were very high, suggesting high add-on costs. The effect of add-on costs
in the distribution chain on medicine prices was unfortunately not clear in all countries, as many
countries did not report multiple price types (some countries reported no more than one price
point per medicine).
A final general remark regarding the quantitative price analysis relates to the use of MSH
reference prices for the comparison of the 7 selected medicines. Namely, that MSH reference
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 106
prices are largely Ex-Works and are based on the median price of mainly non-profit suppliers and
therefore might not be suitable for comparison with every country and every price type. However,
MSH is a constant factor for comparison and little fluctuation is observed in prices over time (e.g.
low difference between MSH 2008 and MSH 2009). Therefore it is not expected that the use of
MSH prices from 2008 will influence the comparability with newer or older prices (except for
medicines that are recently off-patent, which have not been selected for the price comparisons).
When considering the use of web-based price information for external reference price setting, the
key findings from this quantitative analysis of seven medicines should be taken into account. With
the exception of the New Zealand ex-factory prices (reporting 6 out of the 7 medicines) and Tamil
Nadu procurement prices (reporting 5 out of the 7 medicines), there was no consistency as to
which website reported the lowest prices. In addition, there was little correlation between national
GDP (Gross Domestic Product) per capita and prices. Therefore a wide range of countries should
be included in the reference basket and the average (or median) of the three lowest prices should
be used as the reference. Where countries use the average of a large number of countries (as
Austria does) the final price will inevitably be high.
Generic therapeutic substitution
In this analysis, two brand medicines were compared to their generic therapeutic equivalent
substance to investigate the potential cost savings of generic therapeutic substitution. The prices
of the brand of atorvastatin, Lipitor (Pfizer) 20mg cap/tab were compared to the INN generic
simvastatin 20mg cap/tab; while the brand of esomeprazole, Nexium (Astra Zeneca) 20mg was
compared to the INN generic omeprazole 20mg cap/tab. All branded atorvastatin products
manufactured by Pfizer were included (e.g. Lipitor, Sortis, Tahor and Torvast), as were all
esomeprazole products manufactured by Astra Zeneca (e.g. Nexium, Nexiam and Inexium).
It should be noted that both Lipitor and Nexium were matched on dosage strength (both 20mg
brand compared to 20mg generic) and not on their supposedly therapeutic equivalent dosage
strength. This comparison should merely be looked at as a comparison of equivalent
pharmaceutical substances. While there are slight differences in the therapeutic effect of these
products in practice they are often used interchangeable. Statins may be titrated against
cholesterol levels but are frequently used empirically. Several studies suggest that atorvastatin is
slightly more potent in lowering low-density lipoprotein cholesterol (LDL-C) than simvastatin.
(14,15, 16) The results of the CURVES study (15) showed reductions in LDL-C of 28% to 41% for
simvastatin 10 to 40mg, as opposed to 38% to 51% for atorvastatin 10 to 40mg. Atorvastatin
20mg reduced LDL-C 46%, while simvastatin reduced LDL-C 35%; only the reductions at the
40mg dose (41% vs. 51%) were considered statistically significant. (15) The results of the IDEAL
study (14) also showed greater reductions in LDL-C for atorvastatin compared to simvastatin.
However, although this reduced the risk of secondary end points and nonfatal acute Myocardial
Infarct (MI), it did not result in a significant reduction in the primary outcome of major coronary
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 107
events (e.g. fatal MI). (14) As discussed, the CURVES study showed atorvastatin 20mg (-46%)
reduced LDL-C levels more than simvastatin 20mg (-35%) and even simvastatin 40mg (-41%);
thus atorvastatin could be seen as more potent. It must however be noted that the difference in
prices was much greater than the found differences in potency. As Ara et al. stated (16),
atorvastatin will be the more cost-effective treatment if the cost decreases (patent ends in 2011)
to that observed for simvastatin.
A similar discussion point is applicable for the comparison of omeprazole and esomeprazole. It is
suggested that esomeprazole provides more effective acid control than omeprazole. (17,18)
Esomeprazole 40mg proved to be about 6% to 10% more potent than omeprazole 20mg in acute
treatment in a UK study. (18) The increased effect of esomeprazole when administering the same
dosage appeared (both 40mg) to be 13% to 20%. (17) Once again it must however be noted, as
concluded by Wahlqvist et al. (18), that the cost of esomeprazole needs to be reduced in order for
esomeprazole to become the more cost-effective treatment.
Because a MSH reference price was not available for either medicine, the price of simvastatin
and omeprazole respectively, were used as a reference. To compare prices between sources, a
country price ratio was calculated: price of Lipitor or Nexium in country A divided by the price of
simvastatin or omeprazole in country A. The comparison of prices was therefore more difficult as
the prices of both simvastatin and omeprazole are different in each country. Also, the availability
of price data was substantially less than in the other 7 comparisons, but still high enough to
analyze the benefits of generic therapeutic substitution.
When comparing the prices of Lipitor and Nexium with their therapeutic equivalents, it was seen
that all of the prices of Lipitor and Nexium were far higher. In fact, differences up to 214-fold
(procurement price of Denmark) for Lipitor compared to simvastatin and differences up to 41.1
(wholesale price of Sweden) for Nexium compared to omeprazole were reported. In the Lipitor
comparison, the retail/patient prices of INN generic atorvastatin were also included in the
comparison. Although these prices were also higher than those of simvastatin, they were
remarkably lower (median ratio of 1.98-fold and a mean ratio of 3.16-fold) than the simvastatin
price. These substantial price variations clearly show the potential cost savings of generic
therapeutic substitution of simvastatin for Lipitor and omeprazole for Nexium.
In conclusion, many websites are fast and user-friendly, but they often report different price
information and have key limitations which users should take into consideration. The quantitative
analysis of 7 selected medicines in this study has proven that it is possible to conduct
international price comparisons using the price information on the identified websites, but it is
demanding work. Comparisons are possible for a selection of medicines, but when comparing
multiple medicines the use of multi-national price sources should be considered. Looking at the
price comparisons in general it is surprising that although medicine price information appears to
be widely available on the internet, great variations in prices still exist. The substantial price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 108
variations observed in the Lipitor and Nexium price comparisons showed that generic therapeutic
substitution is a policy measure that should be more widely practiced.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 109
VII - RECOMMENDATIONS
Recommendations for webmasters on general site quality
The comprehensiveness of the general information on a website reporting medicine prices is
considered a major criterion in its evaluation, regardless of the publisher and the website's
primary objective.
Update: site & price
Websites should display the date on which the general site was last updated to show users how
recent the information on the website is. Displaying the date of last update of the price data is
considered equally important. Only then will users be able to interpret all information available on
the website in an appropriate manner.
Example
Three USA websites - PBM (http://www.pbm.va.gov/DrugPharmaceuticalPrices.aspx), CHFS
(http://chfs.ky.gov/dms/maximum.htm) and CDC (http://www.cdc.gov/vaccines/programs/vfc/cdc-
vac-price-list.htm) - are considered good examples. General and price-specific information are
updated at least once a month.
Search option within price information
The ability to search medicine prices can be very useful. It saves time (no need to scroll down a
long list), especially when medicines are listed by brand name (varies throughout countries) or
manufacturer name rather than alphabetized by INN name.
Example
The price information database on the Swedish website (http://www.tlv.se/beslut/sok/lakemedel/)
can be searched by INN name, drug name, manufacturer or ATC code. Moreover, in the excel
document that can be downloaded from the database, the display can be modified by individual
characteristic (e.g. only display amoxicillin, only display generics, only display wholesale price).
Parent/child relationship
Some of the national websites that were reviewed did not link to the homepage of the
source/author. The inclusion of a link to the main website (parent) of the organization/author of
the pricing website (child) is recommended. This ensures that users are properly informed about
the objectives of both the author and the pricing website.
Example
The Danish price database website has a good parent/child relationship. It is a theme website of
the Danish Medicines Agency and although both have a different web address, the medicine
prices theme website (http://www.medicinpriser.dk/) is situated in the general website frame of
the Danish Medicines Agency (http://www.dkma.dk). This allows the information and features of
both websites, such as site map, search engine and contact information, to be easily accessed
(less than 5 mouse clicks) using either of the two website links.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 110
Site map
The inclusion of a site map improves the user friendliness of a website, as it facilitates navigation
for the user. Moreover, it provides an overview of the various types of price information available
on the website.
Example
A clear site map can be found on the PHARMAC website from New Zealand
(http://www.pharmac.govt.nz/sitemap/). The website is divided into 4 separate sections; the site
map is therefore divided into these 4 sections as well. Moreover, all subjects listed in the site map
are active links to that subject on the website.
Print/download version
A downloadable version of the published price information is recommended. Price information
can be updated or removed and in this way one can secure data (e.g. for price comparisons) at
different times. A downloadable version could include either individual search results or the entire
database (both is ideal). A print version is useful for the same reason and is also recommended.
Example
Two websites providing both a print and download format of the price information are those of
Lebanon (http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx) and Morocco
(http://www.assurancemaladie.ma/anam.php?id_espace=6). For Lebanon a downloadable format
of the prices is accessible above the prices search engine, while for Morocco the downloadable
format is available below the prices search engine. Both websites also include a 'print screen'
feature in their searches box.
Links to other price reporting websites
Not all websites link to other price reporting sites, something that would be useful when
conducting international price comparisons. In particular, when sites have used other websites as
data sources, it is recommended that they publish links to these sources as a minimum.
In all cases it is recommended that websites link to the WHO listing of pricing websites
(http://www.who.int/medicines/areas/access/ecofin/en/index.html).
ExampleThe CEDD website was one of the few sites reporting links to other price reporting
websites. The useful links page (http://cedd.oep.hu/) featured links to drug price lists, drug prices
and other links (e.g. governmental and health organizations).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 111
Recommendations for webmasters & database authors on medicine price
reporting
The comprehensiveness of the descriptive information accompanying price data is a major
criterion in the evaluation of websites, regardless of the website's primary objective and publisher.
Medicines listed by INN name
An International Nonproprietary Name (INN) is unique for each medicine and globally recognized.
The INN name of a medicine is the same in every country, while brand names differ per country.
As such, the use of INN names facilitates the identification of pharmaceutical substances and
thus facilitates international comparisons across different sources. Therefore it is strongly
recommended that pricing websites list medicines by their INN name (and not on the brand
name) in order to improve general user friendliness as well as the comparability of price
information.
Example
Three UK websites - eMIT (http://www.cmu.nhs.uk/Medicines/Generic/Pages/eMIT.aspx), Drug
Tariff for England&Wales (http://www.ppa.org.uk/ppa/edt_intro.htm) and Drug Tariff for Scotland
(http://www.isdscotland.org/isd/2246.html) list all medicines on INN name and not on brand name
to improve search ability and comparability.
Additional charges included in published price
Access to information on the add-on costs included in a price is important for achieving a fair
international price comparison.
Ex-factory and procurement prices should include INCO terms, and when insurance and freight
are included in the price their value should be specified (preferably in real amounts or a
percentage).
For wholesale prices it should be clear if logistic fees and taxes are included, and if so their value
should be specified (preferably in real amounts or a percentage).
For reimbursement and retail/patient prices it is important to know whether or not dispensing fees,
taxes (e.g. VAT/GST) and/or co-payments are included in the published price. If any of these are
included their value should be specified (preferably in real amounts or a percentage).
Example
The website of the Netherlands (www.medicijnkosten.nl) clearly lists that the price reported
includes VAT, but that a dispensing fee is not included. Although specifications are given on the
dispensing fee, the value of the included VAT is not specified on the website.
Exchange rate used
Clear information on the date of origin of the prices reported is not always available. This should
be published, as well as the US$ exchange rate at that time (weekly/monthly fluctuations).
Even if the price is reported in the countries' local currency, the US$ exchange rate at the time
the price information should be reported.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 112
Example
The CEDD website reports prices in Euros (€); the exchange rate of € to the national currencies
of the Czech Republic, Hungary, Latvia, Lithuania, Norway, Poland and Slovakia at the date of
the price information are published on top of the price information. The exchange rate can be
adjusted manually and results in Euros will immediately be changed to this new exchange rate.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 113
Recommendations for users of websites for price comparisons
For users of websites reporting medicine prices, some general recommendations are listed
below. As users can seek information on medicine prices for various reasons, and can come from
different backgrounds (e.g. country differences such as strong generic or originator market), it is
difficult to give specific recommendations on topics such as policy implications.
Price data collection
Medicines should be searched by their INN name to achieve a large sample size because, in
contrast to a brand name, this is a universal name and reported on many national and
international sites.
Website selection
National websites should be used for country price comparisons of a small selection of medicines
only, as comparing medicine prices across many different sources is very demanding (differences
in explanatory price information).
International multi-country source websites, such as the Hungarian CEDD website (European
comparisons (ex-factory, wholesale and retail prices)) and the MSH website (comparisons of
developing countries (non-profit procurement prices only)), should be used for price comparisons
consisting of more than 10 medicines.
The websites of international health organizations, such as MSF and WHO, should be used for
price comparisons of disease-specific medicines (e.g. antiretrovirals).
International price comparisons
In general, United States dollars (US $) are used for price comparisons between countries. This
study has shown that medicine prices are generally reported in the country's national currency
and an exchange rate to US $ is not reported.
One-on-one country comparisons
When conducting international comparisons of medicine prices, a currency should be chosen that
is used by many of the countries included in the analysis. For example, as most prices in Europe
are reported in Euros (€), this currency should be used in price comparisons across European
countries.
Price comparison using MSH reference prices
As MSH reference prices are reported in US $, this currency should be used for price
comparisons that include MSH prices. For optimal accuracy, a currency exchanger should be
used that provides exchange rates on a daily basis (in this study OANDA was used:
http://www.oanda.com/).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 114
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 115
VIII - CONCLUSION Many publicly available websites reporting medicine prices are available on the internet from both
national and international sources. Most of these websites are fast and user-friendly, but they
often report different price information and lack key information to perform valid international price
comparisons. Actual price information can be compared across various price sources but the
seven medicine comparisons conducted in this study showed that this is very demanding work.
More extensive comparisons using all national websites would be even more demanding;
therefore, the use of international websites such as the Hungarian CEDD website should be
considered for price comparisons. Although a comparison of prices is also possible using a small
selection of national websites, a reasonable outcome can only be expected when using multiple
sites.
The usefulness of price comparisons is limited by the lack of comparability of price data across
sites. If a high number of price data points is available and a wide range in prices is observed, as
in this study, a conclusion based on this wide range would still be considered useful. While some
variation would be expected due to comparability issues, these alone would not account for large
scale price variation. However, when only a small range of price data points is available it is more
difficult to determine the potential influence of comparability issues on the results. Looking at the
price comparisons in general as well as their results it is surprising that although medicine price
information appears to be widely available on the internet, great variations in prices still exist.
Even within similar countries (e.g. similar WHO region and country income class) large price
variations were observed. The results of the Lipitor and Nexium price comparisons were equally
surprising, showing that generic therapeutic substitution is still not widely practiced.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 116
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 117
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4. Andersson F. Methodological Aspects of International Drug Price Comparisons. Pharmacoeconomics. 1993;4:247-56.
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6. Cornips C, Rägo L, Azatyan S, Laing R. Medicines Regulatory Authority websites: a quantitative and qualitative review of progress made since 2001. 2009.
7. International HA, Organization WH. Measuring medicine prices, availability, affordability and price components. Falvey M, editor2008.
8. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373:240-9.
9. Brekke KR, Holmas TH, Straume OR. Are pharmaceuticals inexpensive in Norway? A comparison of prices of prescription pharmaceuticals between Norway and nine west European countries. Bergen, Norway: The institute for research in economics and business administration2008.
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11. Vitry A, Lexchin J, Sasich L, Duprin-Spriet T, Reed T, Bertele V, et al. Provision of information on regulatory authorities' websites. Internal Medicine Journal. 2008;38:559-67.
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14. TJ. P, al. e. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction. The IDEAL study: A randomized controlled trial. Journal Of the American Medical Association. 2005;294:2437-45.
15. Jones P, Kafonek S, Laurora I, Hunninghake D. Comparative Dose Efficacy Study of Atorvastatin Versus Simvastatin, Pravastatin, Lovastatin, and Fluvastatin in Patients With Hypercholesterolemia (The CURVES Study). American Journal of Cardiology. 1998;81:582-7.
16. Ara R, Pandor A, Stevens J, Rees A, Rafia R. Early high-dose lipid-lowering therapy to avoid cardiac events: a systematic review and economic evaluation. Health Technology Assessment. 2009;13(34).
17. Röhss K, Hasselgren G, Hedenström H. Effect of Esomeprazole 40 mg vs Omeprazole 40 mg on 24-Hour Intragastric pH in Patients with symptoms of Gastroesophageal Reflux Disease. Digestive Diseases and Sciences. 2002;47(5):954–8.
18. Wahlqvist P, Junghard O, Higgins A, Green J. Cost effectiveness of esomeprazole compared with omeprazole in the acute treatment of patients with reflux oesophagitis in the UK. Pharmacoeconomics. 2002;20(4):279-87.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 119
ANNEX I
Descriptive characteristics for websites reporting medicine prices
To classify the websites and the type of price information they contain, the following descriptive
characteristics will be used.
Source of website
o National: non-profit (e.g. government, non-governmental organizations)
o National: for-profit (e.g. wholesaler, health insurance)
o International: non-profit (e.g. multi-country databases, non-governmental organizations)
o International: for-profit (e.g. manufacturer)
General information
o Internet address (link)
o Country or organization behind the website (author)
o Basis for access (free to access?)
o Database or other format
o Languages available: national, English, French, Spanish
Type of price information
o Ex-factory / manufacturer
� INCO term
o Procurement
� INCO term
� taxes, duties and other charges included?
o Wholesale
� taxes, duties and other charges included?
o Reimbursement
� taxes, duties and other charges included?
� co-payment or without co-payment?
� dispensing fee included?
o Retail / Patient
� taxes, duties and other charges included?
� co-payment or without co-payment?
� dispensing fee included?
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 120
ANNEX II
NATIONAL MEDICINE PRICE SOURCES
COUNTRY TITLE WEBSITE Australia Schedule Pharmaceutical
Benefits http://www.pbs.gov.au/html/home
Austria The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Bahrain Ministry of Health http://www.moh.gov.bh/EN/E-services/DrugPrices.aspx
Belgium Institut national d'assurance maladie-invalidité / Rijksinstituut voor ziekte- en invaliditeitsverzekering
http://www.inami.fgov.be/drug/fr/drugs/index.htm (2 databases accessible: reimbursement reference pricing and pharmaceutical specialties)
Brazil Banco de Precos Em Saude
http://bpreco.saude.gov.br/bprefd/owa/consulta.inicio
Canada Patented Medicine Prices Review Board (PMPRB)
http://www.pmprb-cepmb.gc.ca/english/view.asp?x=572
Canada Ontario Drug Benefit
Formulary / Comparative Drug Index
http://www.health.gov.on.ca/english/providers/program/drugs/odbf_mn.html
Czech Republic
State Institute for Drug Control
http://www.sifdc.eu/index.php?lang=2
Czech Republic
The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Denmark Medicin priser http://www.medicinpriser.dk/
Finland The Common European Drug Database (CEDD)
http://cedd.oep.hu/
France L'assurance maladie - Base des Médicaments et Informations Tarifaires
http://www.codage.ext.cnamts.fr/codif/bdm_it/index_presentation.php?p_site=
France
Ministry of Health http://medicprix.sante.gouv.fr/welcome.do
France
Ameli l'Assurance Maladie (Reimbursement percentages)
http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/medicaments-et-vaccins/remboursement-des-medicaments-et-tiers-payant/quels-remboursements-pour-vos-medicaments.php
Germany German DIMDI reimbursement prices
http://www.dimdi.de/static/en/amg/fbag/index.htm
Hungary The Common European Drug Database
http://cedd.oep.hu/
India National Pharmaceutical Pricing Authority
http://www.nppaindia.nic.in/prnotif2001/pr-not-ind-01.html
India Tamil Nadu Medical Services Corporation
http://www.tnmsc.com/
Iran Ministry of Health and Medical Education: Food and Drug Department
http://www.fdo.ir/Drug/Fa/Downloads/ShowSection.aspx?fid=11
Ireland The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Italy L'Agenzia Italiana del farmaco (AIFA)
http://farmaco.agenziafarmaco.it/index.php
Jordan Jordan Food and Drug Administration (JFDA)
http://www.jfda.jo/barcode_java/index.jsp
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 121
COUNTRY TITLE WEBSITE Latvia The Common European
Drug Database (CEDD) http://cedd.oep.hu/
Lebanon Ministry of Public Health: Drugs Public Price List G
http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx
Lithuania The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Morocco Agence Nationale de L'assurance Maladie
http://www.assurancemaladie.ma/anam.php?id_espace=6&id_srub=19
Netherlands College voor Zorgverzekeringen (CVZ)
http://www.medicijnkosten.nl/
New Zealand The Pharmaceutical Management Agency (PHARMAC)
http://www.pharmac.govt.nz/healthpros
Norway The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Norway
Statens legemiddelverket http://www.legemiddelverket.no/templates/InterPage____38824.aspx?filterBy=CopyToMedecs
Oman Ministry of Health http://www.moh.gov.om/nv_menu.php?fNm=pharma/internetprices.htm&SP=1
Poland The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Portugal National Authority of Medicines and Health products) INFARMED
http://www.infarmed.pt/infomed/inicio.php
Portugal Guia dos Medicamentos Genéricos e Precos de Referència
http://www.infarmed.pt/genericos/menu.html
Slovakia The Common European Drug Database (CEDD)
http://cedd.oep.hu/
Slovenia The Common European Drug Database (CEDD)
http://cedd.oep.hu/
South Africa Department of Health http://www.doh.gov.za/docs/misc/asepi-f.html
South Africa Department of Health - Database of Medicine Prices
http://www.doh.gov.za/department/medic_prices-f.html
South Africa Treatment Action Campaign: Public sector ARV tender prices
http://www.tac.org.za/community/node/2027
Spain Agencia Espana de Medicamentos y Productos Sanitarios (AEMPS)
https://sinaem4.agemed.es/consaem/fichasTecnicas.do
Spain
Informacion de Medicamentos y Principios Activos
http://www.vademecum.es/
Sudan Federal Pharmacy and Poisons Board - Sudan Index
http://www.nmpb.gov.sd/drugsearch.php
Sweden The Dental and Pharmaceutical Benefits Agency (TLV)
http://www.tlv.se/in-english/
Tunisia La Pharmacie Centrale de Tunisie
http://www.phct.com.tn/fr/produits.php#
United Kingdom
Drug Tariff for Scotland http://www.isdscotland.org/isd/2245.html
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 122
COUNTRY TITLE WEBSITE United Kingdom
NHS Generic Pharmaceuticals electronic Market Information Tool (eMIT)
http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Pharmaceuticals/
United Kingdom
NHS Dictionary of Medicines and Devices (DMD)
http://www.dmd.nhs.uk/dictionary
United Kingdom
British National Formulary (BNF)
http://bnf.org/bnf/index.htm
United Kingdom
National Health Service Drug Tariff for England and Wales
http://www.ppa.org.uk/ppa/edt_intro.htm
United States Department of Veterans Affairs
http://www.pbm.va.gov/ContractsAndAgreements.aspx
United States MEDICAID http://www.cms.hhs.gov/Reimbursement/
United States Kentucky MEDICAID Services
http://chfs.ky.gov/dms/maximum.htm
United States Centers for Disease Control (CDC) - Vaccine Price List
http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm
Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! NATIONAL PRICE SOURCES http://www.haiweb.org/medicineprices/national-medicine-prices-sources.php
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 123
ANNEX IIIa
INTERNATIONAL MEDICINE PRICE GUIDES
ORGANISATION(S) TITLE WEBSITE Clinton Foundation Antiretroviral (ARV) price list http://www.clintonfoundation.org/what-we-
do/clinton-hiv-aids-initiative/information-center-resources
Global Fund to fight AIDS, TB & Malaria
Price & Quality Reporting (PQR)
http://www.theglobalfund.org/en/procurement/pqr/
Health Action International
Medicine Prices, Availability, Affordability & Price Components
http://www.haiweb.org/medicineprices/
Health Action International
WHO/HAI database of medicine prices, availability, affordability and price components
http://www.haiweb.org/GlobalDatabase/
International Trade Centre / World Health Organization
The market news service for pharmaceutical starting materials
http://www.intracen.org/mas/mns.htm
Management Sciences for Health
International drug price indicator guide
http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English
Médecins Sans Frontières
Untangling the web of antiretroviral price reductions
http://utw.msfaccess.org/
Insurance Fund Administration of Hungary
European Drug Database (CEDD)
http://cedd.oep.hu/
WHO Western Pacific Region
Price Information Exchange (PIE) for selected medicines
http://piemeds.com/
Österreichisches Bundesinstitut für Gesundheitswesen (OBIG) (Austria)
Pharma price information (PPI) http://www.goeg.at/en/PPI
AIDS Medicines and Diagnostics Service (AMDS) (WHO)
Global Price Reporting Mechanism (GPRM)
http://www.who.int/hiv/amds/gprm/en/index.html
WHO / UNICEF / Roll Back Malaria Partnership / Management Sciences for Health / Population Services International
Sources and prices of selected products for the prevention, diagnosis and treatment of malaria
http://www.who.int/medicines/areas/access/AntiMalariaSourcesPricesEnglish.pdf
WHO AFRO Essential medicines price indicator
http://www.afro.who.int/en/divisions-a-programmes/dsd/essential-medicines.html
WHO, PAHO PAHO Strategic Fund reference prices
http://new.paho.org/hq/index.php?option=com_content&task=view&id=1042&Itemid=988
WHO, UNICEF Sources and prices of selected medicines for children
http://www.unicef.org/supply/files/Sources_and_prices_of_selected_medicines.pdf
Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! MULTI-COUNTRY PRICE SOURCES http://www.haiweb.org/medicineprices/international-medicine-prices-sources.php
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 124
ANNEX IIIb
INTERNATIONAL MEDICINE PRICELIST SOURCES
ORGANISATION(S) TITLE WEBSITE Action Medeor Deutsches Medikamenten-
Hilfswerk http://gb.medeor.org/Professionals/Products/New-Price-Indicator.html
Action Medeor International Healthcare
Not-for profit procurement agency in Tanzania
http://www.medeor.org/Professionals/medeor-Tansania/Medikamenten-Hilfe
Durbin PLC International sales - Medical supplies
http://www.durbin.co.uk/exports_catalogue.htm
Global Drug Facility (tuberculosis)
Product catalogue http://www.stoptb.org/gdf/drugsupply/drugs_available.asp
IDA Foundation Web catalogue http://www.idafoundation.org/we-offer/web-catalogue.html (login!!)
IDA HIV/AIDS Group Web catalogue http://www.idafoundation.org/we-offer/web-catalogue/category/hivaids-related-products.html (login!!)
Joint Medical Stores Private-not-for profit NGO http://www.jms.co.ug/downloads.html Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! MULTI-COUNTRY PRICE SOURCES http://www.haiweb.org/medicineprices/international-medicine-prices-sources.php
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 125
ANNEX IV Qualitative Country Annex
African Regional Office (AFRO) SOUTH AFRICA
- www.doh.gov.za/docs/misc/asepi-f.html
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Department of Health
General information
o Country or organization behind the website
� South Africa, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� downloadable excel pricelist, individual list for every manufacturer (ZIP files)
o Languages available
� English
Country: South Africa Website: www.doh.gov.za/docs/misc/asepi-f.html Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: start screen on homepage does not have a clear layout with all the different formats and colors, but this page changes into a screen with a clear layout after one click; * Update: no information available on date of creation of website or on last update of website, price lists manufacturers last updated on 06-10-2009; * Site map/search: useful search engine, a search on INN name links to documents with prices listed and to documents with background information, but no site map available on site; * Search within prices: prices are listed in A-Z listing on manufacturer name and not on INN name, no quick scanning of documents possible, difficult to compare prices of the same product between different manufacturers;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 126
* Download/print version: no print version available, downloadable ZIP files with prices; * Author information: disclosure of source and contacts of employees of Ministry of Health on website, furthermore a document containing the 'Reference Price List 2009 Statement' is posted above downloadable documents and contains direct contact information to responsible author; * Links: useful national links (incl provincial health websites), international links, specific links on HIV/AIDS topics, but no links to other price reporting websites; * Additional price information: following prices (or components) are shown: - new increased ex-manufacturers price (excl VAT) - new logistics fee (excl VAT) - value added tax (VAT) � specified amount, not percentage - new single exit price (SEP), after the increase (incl VAT) - unit price � price per tablet, per ml, … INDICATIVE! South Africa - Manufacturer lists
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit INCO term X Logistics fee listed (specified
amount per medicine) but not which INCO term is used
Exchange rate (if not national currency) NA NA South African Rand (ZAR) = National currency
Date of price information X 05-02-09 t/m 30/09/09 Price type X Reference price list, individual list
for each manufacturer Quality X Pharmacopoeial specifications X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 127
SOUTH AFRICA
- www.doh.gov.za/department/medic_prices-f.html
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Department of Health
General information
o Country or organization behind the website
� South Africa, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� downloadable excel pricelist
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: start screen on homepage does not have a clear layout with all the different formats and colors, but this page changes into a screen with a clear layout after one click; * Update: no information available on date of creation of website or on last update of website, price lists manufacturers last updated on 22-04-2010; * Site map/search: useful search engine, a search on INN name links to documents with prices listed and to documents with background information, but no site map available on site; * Search within prices: prices are listed in individual documents for every manufacturer, not clear which manufacturer produces which medicines and no option to find out besides downloading all documents and manually checking for medicines; * Download/print version: no print version available, downloadable ZIP document with prices; * Author information: disclosure of source and contacts of employees of Ministry of Health on website, furthermore a document containing the 'Call for submissions on the schedule of medicine prices' is posted in same window as price document and contains direct contact information to responsible author; * Links: useful national links (incl provincial health websites), international links, specific links on
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 128
HIV/AIDS topics, but no links to other price reporting websites; * Additional price information: following prices (or components) are shown: - new increased ex-manufacturers price (excl VAT) - new logistics fee (excl VAT) - value added tax (VAT) � specified amount, not percentage - new single exit price (SEP), after the increase (incl VAT) - unit price � price per tablet, per ml, … South Africa - Medicine price list
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit INCO term X Logistics fee listed (specified
amount per medicine) but not which INCO term is used
Exchange rate (if not national currency) NA NA South African Rand (ZAR) = National currency
Date of price information X 05-02-09 t/m 30/09/09 Price type X Actual prices, exclusive of logistics
fee and VAT Quality X Pharmacopoeial specifications X South Africa - Medicine price list
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit Volume X Exchange rate (if not national currency) NA NA South African Rand (ZAR) =
National currency Date of price information X Price type X Actual prices, including logistics
fee and VAT(amounts specified) Taxes & duties & other charges X Logistics fee and VAT included
(amount specified)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 129
SOUTH AFRICA
- www.tac.org.za/community/node/2027
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Treatment Action Campaign (TAC)
General information
o Country or organization behind the website
� South Africa, Treatment Action Campaign (TAC)
o Basis for access
� free to access, no registration
o Database or other format
� downloadable excel pricelists; public sector antiretroviral tender prices, private sector
antiretroviral (and other) single exit prices
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x x � Combined score accessibility of information 1/1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information available on date of creation of website or on last update of website, public sector antiretroviral tender price list is valid until 31-05-2010 (24 month contract), private sector antiretroviral (and other) single exit prices updated weekly; * Site map/search: site map available on site, but no useful search engine (no search on INN name possible); * Search within prices: prices are listed in A-Z index according to INN name, but no search option within ZIP document or online prices list; * Download/print version: private sector single exit medicine prices are available online, as a print version and in a download version; public sector price list is only available in print version; * Author information: disclosure of source and contacts of employees of TAC on website contains direct contact information to responsible author; * Links: useful national links (most link to a topic on TAC site), but no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 130
* Important note: People in South Africa obtain medicines either through the public health system or from private dispensing doctors and pharmacies. - Public health system: patients receive medicines for free but have to put up with extraordinarily long queues and inconsistent service. The state buys medicines for the public sector, usually but not always via a tender process. - Private sector: patients are usually insured by a medical scheme to which they pay a monthly premium. Pharmaceutical companies sell medicines at a single exit price to the private sector. South Africa - Antiretrovirals - Public sector tender prices
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Supplier X Volume purchased X Minimum purchase order Purchase terms X Payment terms / timelines X Date of price information X Tender prices: contract valid 01-
06-08 until 31-05-10 Date of procurement award X Exchange rate at time of award X South African Rand (ZAR) =
National currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Prices including VAT (14%) South Africa - Antiretrovirals - Private sector single exit prices
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Price per volume Exchange rate (if not national currency) NA NA South African Rand (ZAR) =
National currency Date of price information X 26-04-10 (weekly updated) Price type X Single exit price (actual prices),
excluding or including VAT Taxes & duties & other charges X Price with and without VAT listed
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 131
ANNEX V Qualitative Country Annex
The Americas Regional Office (AMRO)
BRAZIL
- http://bpreco.saude.gov.br/bprefd/owa/consulta.inicio
Website accessed on: 19-04-2010
Source of website
o National: for-profit
� Banco de Preços em Saude
General information
o Country or organization behind the website
� Brazil, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Portuguese, Spanish, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, prices last updated in 2008; * Site map/search: no site map available on website, search engine provides search on item type (medicines, hospital medical equipment, medicinal gases, nutrition - food, health services) but no search by INN name possible; * Search within prices: database listed as an A-Z index by INN name, classification, institution, or as a report with minimum and maximum prices; * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on Ministry of Health), no contact information listed (not even general contact information); * Links: no useful links, not even a link to the main page of Ministry of Health, nor links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 132
Brazil
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X INCO term X Supplier X Volume purchased X Total quantity purchased Purchase terms X Payment terms / timelines X Date of price information X Variable dates: 2006 to 2008 Date of procurement award X Exchange rate at time of award X Prices can be shown in
Brazilian Real, Dollar Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 133
CANADA
- http://www.pmprb-cepmb.gc.ca/english/view.asp?x=572
Website accessed on: 16-04-10
Source of website
o National: non-profit
� Patented Medicine Prices Review Board (PMPRB)
� Conseil d' Examen du Prix des Médicaments Brevetés (CEPMB)
General information
o Country or organization behind the website
� Canada, PMPRB is part of the Health Portfolio but operates independently from the
Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� A-Z index with new patented drugs, individual documents (per drug)
o Languages available
� English, French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: price information is collected during introductory period just after receiving patent, therefore different price data, but most data from several years ago; * Site map / Search: no site map available, search options by INN name and by brand name; * Search within prices: easy to access A-Z index of all patented medicines in Canada; * Download/print version: download version available per medicine, not one database list; * Links: none available on the website; * Consumer Price Index (CPI)-Adjustment factors for 2010: To allow patentees to set prices in advance, the Board´s CPI-Adjustment Methodology provides for the calculation of the CPI-Adjustment factors based on forecast changes in the CPI. The Board informs patentees on an annual basis of the CPI-adjustment factors for future pricing period. * Exchange rates for International Price Comparisons: The methodology for calculating exchange
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 134
rates for purposes of the PMPRB´s International Price Comparisons is described in Schedule 3 of the Compendium of Guidelines, Policies and Procedures.(http://www.pmprb-cepmb.gc.ca/english/view.asp?x=137&mid=1066) Existing Drug Products "The simple average of the monthly average noon spot exchange rates for each country for the 36-month period ending December 2009 will be used in the review of prices for existing medicines in the second half of 2009. The international prices of an existing drug product for the period January to December 2009 can be converted to Canadian currency for comparison purposes by multiplying the local currency price in each country by the corresponding simple average exchange rate." New Drug Products "The simple average of the monthly average noon spot exchange rates for each country for the 36-months period ending four months before the date of the first sale of the drug product. e.g.: A new drug product first sold in Apr 2007, the exchange rates used are Apr 2007 including four months before the date of the first sale of the drug product as per Guidelines."
Canada - Patented Medicine Prices Review Board Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Originator brand listed Packaging specifications & size X Exchange rate (if not national currency) NA NA Canadian dollar (CA$) =
national currency Date of price information X Variable price dates: price
dependent on patent of medicine (start and end date)
Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 135
CANADA
- www.health.gov.on.ca/english/providers/program/drugs/drugs_program_mn.html
Website accessed on: 19-04-10
Source of website
o National: non-profit
� Ontario Public Drug Programs
General information
o Country or organization behind the website
� Canada, Ontario Ministry of Health and Long-Term Care
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English, French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information
x
Search ability within price information x Download / print version price information x � Combined score accessibility of information
1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting
sites 1
* Update: prices in Ontario Drug Benefit Formulary/Comparative Drug Index effective from 02-03-2010, prices last updated on 13-04-2010; * Site map/search: site map button links to another site, but there's no sitemap on this homepage (www.health.gov.on.ca) and no additional information on Ontario Drug Benefit (ODB) program; search by INN name, by brand name or by DIN/PIN code is possible; * Search within prices: search by INN name, by brand name or by DIN/PIN code possible; * Download/print version: full text of formulary edition 41 (January 2008), all 20 updates (last update effective 23-04-2010) available for download in pdf and excel files; no print version; * Author information: direct link to email address for authors Ontario Public Drug Programs; * Links: useful links to provincial government sites, federal government sites, both national and international health-related sites, but none to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 136
* Conditions for payment of a Dispensing Fee under the ODB Program: In order to receive payment of a dispensing fee under the ODB Program, the dispenser must supply at one time the lesser of : a. the entire quantity of the listed drug product that is specified on the prescription to be dispensed at one time; or b. the maximum quantity permitted under section 18 of the ODBA Regulation 1 (“Maximum Quantity”). 1 For most ODB recipients, the maximum quantity would be a supply sufficient for a 100-day course of treatment; for ODB recipients who are eligible for benefits under the Ontario Works program, the maximum quantity is a 35-day supply; and in the case of medications to which the Trial Prescription Program applies, the maximum quantity for which the EO is required to pay is a quantity sufficient for 30 days. http://www.health.gov.on.ca/english/providers/program/drugs/odbf/odbf_conditions_for_payment.html "In other words, the dispenser is required to dispense at one time the Maximum Quantity unless the prescriber has directed that a smaller quantity be dispensed. In cases where the prescriber has directed the dispensing of a reduced quantity (i.e. less than the Maximum Quantity), the ministry will provide payment for a maximum of two (2) dispensing fees per medication per recipient per calendar month." Canada - Ontario Public Drug Programs
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Incl. formulary listing date Brand name & manufacturer X Packaging specifications & size X Exchange rate (if not national currency) NA NA Canadian dollar (CA$) =
national currency Date of price information X Prices effective from 02-03-
2010; price section updated on 13-04-2010 but unclear what has been updated
Taxes & duties & other charges X Price incl. co-payments X Drug benefit price listed
(patient price) and amount that Ministry reimburses (difference is co-payment)
Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 137
UNITED STATES
- http://www.pbm.va.gov/ContractsAndAgreements.aspx
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Pharmacy Benefits Management Services (PBM)
General information
o Country or organization behind the website
� United States, Department of Veterans Affairs
o Basis for access
� free to access, no registration
o Database or other format
� downloadable excel document containing prices for all schemes
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: last update website 28-04-2010, price list valid until 30-06-2010; * Site map/search: site map available on website, search engine provides advanced search option, search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: database only available in downloadable excel document, no search option within document (random alphabetical order); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on PBM Services and on differences between pricelists, direct contact information to prices author listed; * Links: no useful links nor links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 138
United States - Pharmacy Benefits Management Services Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Package size INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Contract until 30-06-2010 Date of procurement award X Exchange rate at time of award NA NA American dollar (US$) =
national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 139
UNITED STATES
- http://www.cms.gov/Reimbursement/01_Overview.asp#TopOfPage
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Centers for Medicare & Medicaid Services (CMS)
General information
o Country or organization behind the website
� United States, Department of Health & Human Services
o Basis for access
� free to access, no registration
o Database or other format
� downloadable document with federal upper limits (FUL)
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: website in general last updated on 02-04-2010 (cms.hhs.gov changed to cms.gov on this date), last update price information 25-09-2009; * Site map/search: no site map available on website, search engine provides search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: database only available in downloadable pdf document, no search option within document (A-Z listing on INN name); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on CMS Services and about Medicaid, direct contact information to prices author listed; * Links: no useful links nor links to other price reporting sites; * Additional Information: Medicaid Prescription Reimbursement Information by State – Quarter Ending March 2010 http://www.cms.gov/Reimbursement/Downloads/reimbursementchart1q2010.pdf
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 140
United States - Centers for Medicare & Medicaid Services Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size Exchange rate (if not national currency) NA NA American dollar (US$) =
national currency Date of price information X 25-09-2009 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 141
UNITED STATES
- http://chfs.ky.gov/dms/maximum.htm
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Kentucky Department for Medicaid Services
General information
o Country or organization behind the website
� United States, Kentucky Cabinet for Health and Family Services
o Basis for access
� free to access, no registration
o Database or other format
� downloadable pricelist in pdf document
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites * Update: website in general last updated on 20-04-2010 (cms.hhs.gov changed to cms.gov on this date), last update price information April 2010; * Site map/search: site map available on website, search engine provides advanced search, but no search by INN name possible; * Search within prices: database only available in downloadable pdf document, no search option within document (A-Z listing on INN name); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on CMS Services and about Medicaid, direct contact information to prices author listed; * Links: useful national and international links, but no links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 142
United States - Kentucky Department for Medicaid Services Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Generic names only Brand name & manufacturer X Packaging specifications & size X Price per dosage unit Exchange rate (if not national currency) NA NA American dollar (US$) =
national currency Date of price information X 04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 143
UNITED STATES
- http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm
Website accessed on 29-04-2010
Source of website
o National: non-profit
� Centers for Disease Control and Prevention (CDC) Vaccine Price List
General information
o Country or organization behind the website
� United States, Department of Health and Human Services
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English, Spanish (only CDC homepage, not price list)
� website front can also change to the following languages (menu options and a
selection of information in this language, but not all menu options available): Chinese,
French, Russian, Portuguese, German, Italian, Vietnamese, Haitian Creole, Korean,
Tagalog (Filipino)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 0.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: website last updated on 07-04-2010, last update price information 23-04-2010; * Site map/search: site map available on website and A-Z index with all contents, search on INN name in this case not applicable because only vaccine names are listed, a search on vaccine name is possible and search results include background articles and a link to the price database; * Search within prices: database only available online, no search option within prices, vaccines grouped into 4 categories: pediatric/vfc vaccines, adult vaccines, pediatric influenza vaccines, adult influenza vaccines, A-Z listing within categories on vaccine name; * Download/print version: no download version nor print version available;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 144
* Author information: disclosure of source, but no direct contact information to prices author; * Links: useful national and international links on specific health topics, but no links to other price reporting sites; United States – Vaccine Price List
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X X Vaccine name listed Brand name & manufacturer X Packaging specifications & size X Package size INCO term X Supplier X CDC = supplier Volume purchased X Packaging volume Purchase terms X Payment terms / timelines X Date of price information X 23-04-2010 Date of procurement award X Exchange rate at time of award NA NA American dollar (US$) =
national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X X Federal excise tax specified
per vaccine
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 145
ANNEX VI Qualitative Country Annex
Eastern Mediterranean Regional Office (EMRO)
BAHRAIN
- http://www.moh.gov.bh/EN/E-Services/DrugPrices.aspx
Website accessed on: 13-04-2010
Source of website
o National: non-profit
� Ministry of Health
General information
o Country or organization behind the website
� Bahrain, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Arabic, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website not clear, bottom of page: 16-08-2009, web analytic report shows last update 01-04-2010; no specific information available on date or update of price information; * Search: search engine available on website, but search by INN name not possible; * Search ability within prices: A-Z search index, but on brand/product name and not on INN name; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both Bahrain and international websites, but no price reporting links;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 146
BAHRAIN Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength
X X No INN name listed
Brand name & manufacturer X Manufacturer, country of origin and supplier in Bahrain listed
Exchange rate (if not national currency)
NA NA Bahraini Dinar = national currency
Date of price information X Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 147
IRAN
- http://www.fdo.ir/Drug/Fa/Downloads/ShowSection.aspx?fid=11
Website accessed on: 28-04-2010
Source of website
o National: non-profit
� Ministry of Health and Medical Education - Food and Drug Department
General information
o Country or organization behind the website
� Iran, Ministry of Health and Medical Education
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Arabic, partly in English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website in general (date of copyright 2005), but last update price information February 2010; * Site map/search: no site map, no search on INN name possible in general search engine; * Search within prices: search options within database by INN name, by code, by price or by date; * Download/print version: no download version available, but print option for individual search results by clicking them; * Author information: disclosure of source, information on Ministry of Health and their contact information, but no direct contact information to prices author; * Links: some links available to university or governmental websites, but no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 148
Iran
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X X Brand name or INN name (generic products) listed
Brand name & manufacturer X X Brand name or INN name (generic products), no manufacturer listed
Exchange rate (if not national currency) NA NA Iranian Rial = national currency Date of price information X Persian calendar: prices 2008
or 2009 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 149
JORDAN
- www.jfda.jo/barcode_java
Website accessed on 26-04-2010
Source of website
o National: non-profit
� Jordan Food and Drug Administration (JFDA) - Barcode Project
General information
o Country or organization behind the website
� Jordan, Royal Scientific Society & Jordan Pharmaceutical Association
o Basis for access
� free to access, registration required (guest account provided)
o Database or other format
� searchable internet database
o Languages available
� Arabic, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 1 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, prices last updated in 2008; * Site map/search: no site map available on website, search engine provides search on item type (medicines, hospital medical equipment, medicinal gases, nutrition - food, health services) but no search by INN name possible; * Search within prices: search medicines by INN name, trade name, medicine code, store name, manufacturer, bar code, ATC code; * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on JFDA), no contact information listed (not even general contact information); * Links: links to Royal Scientific Society and Jordan Pharmaceutical Association, but no direct link to the main page of Jordan Food and Drug Administration, nor links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 150
Jordan – Pharmacy price Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size listed Volume X Price per box Exchange rate (if not national currency) NA NA Jordanian Dinar = national
currency Date of price information X Price type X Taxes & duties & other charges X Jordan – Public price Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Jordanian Dinar = national
currency Date of price information X Taxes & duties & other charges X Public taxed price listed, but no
specification of amount Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 151
LEBANON
- http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx
Website accessed on: 28-04-2010
Source of website
o National: non-profit
� Ministry of Public Health
General information
o Country or organization behind the website
� Lebanon, Ministry of Public Health
o Basis for access
� free to access, registration required to access additional information on price
conversions of imported medicines (anyone can register, but you need additional
permission to access the documents)
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 1 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: menu options in panel on the left, subcategories per menu option open next to menu panel, logical presentation; * Update: site daily updated, last update price information 27-03-2010; * Site map/search: both are available on the website and searches are possible by brand name (originator) and INN name, however search results are not combined: e.g. search term amoxicillin only provides generics, while search term amoxil only shows the originator brand; * Basis for access: no access fee or registration required to access price information, but registration is required to access additional information such as exchange rates used on imported pharmaceuticals, furthermore special permission is necessary; * Download/print version: a download version of the database is available in the search screen and the search engine is also provided with a button to make a 'print screen' of the displayed
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 152
table with search results, however this print does not show some of the additional information that's only available when scrolling over search results (registration number, strength, packsize, dosage form, pharmacist margin); * Author information: full disclosure of source per department and direct contact information to 'service of pharmacy' the department responsible for the database on medicine prices; * Links: some useful links, national and international, but no links to other pricing websites; Lebanon Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X X Brand name or INN name (generic products) listed
Brand name & manufacturer X Both and country of origin Exchange rate (if not national currency)
NA Lebanese Pound = national currency
Date of price information X 27/03/2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Pharmacist margin included,
amount specified for each product
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 153
MOROCCO
- http://www.assurancemaladie.ma/anam.php?id_espace=6&id_srub=19
Website accessed on: 26-04-2010
Source of website
o National: non-profit
� Agence Nationale de l'Assurance Maladie (ANAM)
General information
o Country or organization behind the website
� Morocco, National Agency of Health Insurance
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information available on last update of site in general (date of creation 2006), price information is dated on 16-04-2010; * Site map/search: both a site map and an useful search engine are available on the website, searches can be performed by medicine name (only originator), by therapeutic class or by DCI (Dénominations Communes Internationales; generic name). Very good feature: below search box examples that match your search term are shown (useful tool in site of e.g. type errors, name differences between countries); * Search within prices: clicking on search results within the table links to another table with all possible hits on INN name (all brands, generic and originator); * Download/print version: a download version of the database is available from the search engine and the search engine is also provided with a button to make a 'print screen' of the displayed table with search results (all details shown); * Author information: disclosure of source and additional information on projects, but no direct contact information for database author (only contact information ANAM in general);
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 154
* Links: useful links, national and international, to governmental sites and those of health authorities, but no links to other pricing websites; Morocco Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength
X
Brand name & manufacturer X Packaging specifications & size X Presentation: box, bottle, etc. Exchange rate (if not national currency)
NA NA Moroccan Dirham = national currency
Date of price information X 24/02/2010 Taxes & duties & other charges X Price incl. co-payments X Reimbursement price listed next
to retail/patient price � difference is co-payment
Price incl. dispensing fee X Morocco Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength
X
Brand name & manufacturer X Exchange rate (if not national currency)
NA NA Moroccan Dirham = national currency
Date of price information X 24/02/2010 Taxes & duties & other charges X Price incl. co-payments X Reimbursement price listed next
to retail/patient price � difference is co-payment
Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 155
OMAN
- http://www.moh.gov.om/nv_menu.php?fNm=pharma/internetprices.htm&SP=1
Website accessed on 23-04-2010
Source of website
o National: non-profit
� Ministry of Health
General information
o Country or organization behind the website
� Sultanate of Oman, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Arabic, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information available on last update of website in general, database with prices is dated on 17-04-2010; * Site map/search: site map available on website as well as a search box, but no searches possible (search not operating); * Download/print version: no download version available, search results with prices and additional information can be printed per individual product (no print version of complete search/database); * Author information: disclosure of source, detailed information on Ministry of Health and their projects and mission statement, and detailed contact information for hospitals, pharmacies and sub-divisions of the Ministry of Health; * Links: links are available on home page to other departments of government and important international organizations (e.g. WHO, UNICEF, EMRO), also list of Ministries of Health at Gulf Countries Council included, but all broken links, no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 156
Oman Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength
X
Brand name & manufacturer X Exchange rate (if not national currency)
NA NA Omani Rial = national currency
Date of price information X 17/04/2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Amount not specified
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 157
SUDAN
- www.nmpb.gov.sd/drugsearch.php
Website accessed on 27-04-2010
Source of website
o National: non-profit
o National: for-profit
� National Medicines & Poisons Board - Sudan Index 2009
General information
o Country or organization behind the website
� Republic of Sudan, National Medicines & Poisons Board (NMPB)
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Arabic, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Clear layout: start screen webpage is search box with some additional information on content of the database above this search box (only in Arabic); * Update: no information available on last update of website in general, database shows a directory with prices of patented drugs in Sudan until the end of 2009 (12-2009); * Site map/search: no site map available, website only consists of search engine and database; * Search within prices: search engine provides search by: INN name, brand name, country of origin, manufacturer, sales agent in Sudan; * Download/print version: no download or print version available of database or search results; * Author information: disclosure of source, but no specific contact information for prices author; * Links: no links available on website, not even a link to main webpage of NMPB; * Additional information: The Sudan Index 2009 lists entry prices into the country for medicines imported from abroad and for national pharmaceutical manufacturers it lists the retail price to the
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 158
public (both prices are procurement). * Important note: all prices are listed in different currencies, this makes it hard to compare between companies and countries of origin (even different currencies within countries) � currencies used: SDG (Sudanese Pound), AED (United Arab Emirates Dirham), $ (US? Canadian? Australian?), € (Euro), SR Sudan Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength
X
Brand name & manufacturer X Both and country of origin Packaging specifications & size X Packsize listed INCO term X Supplier X Agent in Sudan Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2009, but not further specified Date of procurement award X Exchange rate at time of award X Different currencies used
(depending on country of origin) Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Additional information: The Sudan Index 2009 lists entry prices into the country for medicines imported from abroad and for national pharmaceutical manufacturers it lists the retail price to the public (both prices are procurement). Important note: all prices are listed in different currencies, this makes it hard to compare between companies and countries of origin (even different currencies within countries) � currencies used: SDG (Sudanese Pound), AED (United Arab Emirates Dirham), US$, €
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 159
TUNISIA
- http://www.phct.com.tn/fr/produits.php
Website accessed on 28-04-2010
Source of website
o National: non-profit
o National: for-profit
� La Pharmacie Centrale de Tunisie - la santé d'abord
General information
o Country or organization behind the website
� Tunisia, Ministry of Public Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Arabic, French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website in general 20-04-2010, but no information available on last update price information; * Site map/search: no site map, nor general search engine available on website; * Search within prices: search options within database by INN name, by manufacturer, by therapeutic class of the drug; * Download/print version: no download version available, but print option for individual search results by clicking them; * Author information: disclosure of source, information on Ministry of Health and PHCT specific information, contact information for all different departments available; * Links: some links available to national health or governmental websites, but no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 160
Tunisia Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength
X
Brand name & manufacturer X Exchange rate (if not national currency)
NA NA Tunisian Dinar = national currency
Date of price information X Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 161
ANNEX VII Qualitative Country Annex
European Regional Office (EURO)
AUSTRIA
- http://cedd.oep.hu/
Website accessed on: 08-04-10
Source of website
o National: non-profit
� Main Association of Austrian Social Security Institutions
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 01-03-2010; * Site map / Search: both give the option to search by country or by ATC code * Author information: only mentioned that the Main Association of Austrian Social Security Institutions contributed and a link to their website, but no additional information or direct contact information for Austrian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in German, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 162
(meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP. Austria
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Price type X Quality X Pharmacopoeial specifications X Austria
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit of package Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X Austria
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer not listed Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Taxes & duties & other charges X VAT = 10% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 163
BELGIUM
- www.riziv.fgov.be / www.inami.fgov.be
Website accessed on: 07-04-10
Source of website
o National: non-profit
� Rijksinstituut voor ziekte- en invaliditeitsverzekering (RIZIV)
� Institut national d'assurance maladie-invalidité (INAMI)
General information
o Country or organization behind the website
� Belgium, Ministry of Social Affairs
o Basis for access
� free to access, no registration
o Database or other format
� two searchable internet databases: reimbursement reference pricing and
pharmaceutical specialties
o Languages available
� French, Dutch
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 1
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Unclear layout: pull-down tabs for different categories, not easy to see what to find where; * Update: website updated every day, update price information at beginning of each new month; * Download/print: option to print table that lists search results on price information; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both Belgian and international websites, but no price reporting links;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 164
Belgium Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Packaging specifications & size X Pack size listed for every price INCO term Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Price type Quality Pharmacopoeial specifications Belgium
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size listed for every price Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 6%, included in price Price incl. co-payments X Price ceiling is maximum price
reimbursed ('remgeld'), difference with pack price is co-payment
Price incl. dispensing fee X Belgium
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 6%,included in price Price incl. co-payments X Seperate column Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 165
CZECH REPUBLIC
- http://www.sukl.cz
Website accessed on: 20-10-2010
Source of website
o National: non-profit
� State Institute of Drug Control of the Czech Republic
General information
o Country or organization behind the website
� Czech Republic, State Institute of Drug Control
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Czech and partly in English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, price information updated every month; * Site map / Search: site map available in Czech and English, useful general search engine but search results do not include price database, however very useful search engine for medicinal products database (search in Czech and English); * Download/print:no direct print option, database is available in a downloadable excel format; * Author information: full disclosure of source, general and price database specific contact information available on website; * Links: useful links to SUKL partners, including links to other price reporting websites; * Price database: Price information online available in English, download format is only available in Czech, however an explanatory document to translate Czech words used in the excel sheet is available in a download file as well;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 166
Czech Republic – State Institute of Drug Control Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X Czech Koruna (CZK) =
national currency Date of price information X 31-09-2010 Price type X Price ceiling, maximum ex-
factory price Quality X Pharmacopoeial specifications X Czech Republic – State Institute of Drug Control
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Packaging specifications & size X Pack size listed for every price Exchange rate (if not national currency) NA NA Czech Koruna (CZK) =
national currency Date of price information X 31-09-2010 Taxes & duties & other charges X Price incl. co-payments X Difference between
reimbursed amount and rough patient price is co-payment
Price incl. dispensing fee X Czech Republic – State Institute of Drug Control
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Exchange rate (if not national currency) X Czech Koruna (CZK) =
national currency Date of price information X 31-09-2010 Taxes & duties & other charges X Rough payment listed, taxes
not included Price incl. co-payments X Difference between
reimbursed amount and rough patient price is co-payment
Price incl. dispensing fee X Orientation payment and regulatory fee listed
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 167
CZECH REPUBLIC
- http://cedd.oep.hu/
Website accessed on: 08-04-2010
Source of website
o National: non-profit
� State Institute of Drug Control of the Czech Republic
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-04-2009; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the State Institute of Drug Control of the Czech Republic contributed and a link to their website, but no additional information or direct contact information for Czech price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Czech, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 168
Czech Republic
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = CZK 26.523
(adjustable on website to date of access)
Date of price information X 02-04-2009 Price type X Quality X Pharmacopoeial specifications X Czech Republic
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = CZK 26.523
(adjustable on website to date of access)
Date of price information X 02-04-2009 Taxes & duties & other charges X VAT = 9% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 169
DENMARK
- www.medicinpriser.dk
Website accessed on 13-04-2010
Source of website
o National: non-profit
� Lægemiddelstyrelsen
General information
o Country or organization behind the website
� Denmark, Danish Medicines Agency
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Danish, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: prices are updated every fortnight and reimbursements are updated daily; * Site map: only on Danish Medicines Agency site, but includes detailed site map of pricing site; * Author information: not specific for medicine pricing site; * Links: useful links on Danish Medicines Agency website, but no links to pricing sites; * Important note: Medicinpriser.dk is a theme site of the Danish Medicines Agency, although both have a different web link the site medicinpriser.dk is situated in the general website frame of the Danish Medicines Agency (www.dkma.dk). This way site map, contact information and more is still easy to access from medicinpriser.dk (within 5 mouse clicks).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 170
* Conversion from pharmacy purchase price (AIP) to consumer price (ESP): http://www.dkma.dk/1024/visUKLSArtikel.asp?artikelID=9016 (all in Danish Krones (DKK)) � Dispensing fee: excluding VAT=DKK 8.00 and including VAT=DKK 10.00. � Conversion formula AIP to ESP: ESP = 10.00 + 1.25 x (AIP + 0.083 x AIP + 8.71) � the constant 10.00 is the dispensing fee including VAT; ESP is always rounded to the nearest amount divisible by DKK 0.05; � Conversion formula ESP to AIP: AIP = (0.8 x ESP - (8.00 + 8.71)) / (1 + 0.083) � A back calculation should always be performed to make sure that the figure has been rounded to the nearest amount divisible by DKK 0.05; � Note: All calculations do not take into consideration any finishing fees; Denmark – Pharmacy Purchase Price
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Timeframe 05-04-2010 to 13-
04-2010 (daily updates) Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Excl VAT (Pharmacy Purchase
Price ('AIP' in Danish)) Denmark
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) X Website in Danish = prices in
Danish Krones (DKK) = national currency Website in English = prices in Euro (€) (exchange rate unknown)
Date of price information X Timeframe 05-04-2010 to 13-04-2010 (daily updates)
Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Reimbursement and
retail/patient price listed (difference is co-payment)
Price incl. dispensing fee X Fee is DKK 10.0 incl. VAT Fee is DKK 8.0 excl. VAT
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 171
Denmark
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) X Website in Danish = prices in
Danish Krones (DKK) = national currency Website in English = prices in Euro (€) (exchange rate unknown)
Date of price information X Timeframe 05-04-2010 to 13-04-2010 (daily updates)
Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Reimbursement and
retail/patient price listed (difference is co-payment)
Price incl. dispensing fee X Fee is DKK 10.0 incl. VAT Fee is DKK 8.0 excl. VAT
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 172
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 173
FINLAND
- http://cedd.oep.hu/
Website accessed on: 08-04-2010
Source of website
o National: non-profit
� Finnish Ministry of Social Affairs and Health
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-02-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Finnish Ministry of Social Affairs and Health contributed and a link to their website, but no additional information or direct contact information for Finnish price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Finnish, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 174
Finland Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed,
manufacturer name is not Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-02-2010 Price type X Taxes & duties & other charges X Finland
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed,
manufacturer name is not Exchange rate (if not national currency) X Euro (€) = national currency Date of price information X 02-02-2010 Taxes & duties & other charges X VAT = 8% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 175
FRANCE
- http://www.codage.ext.cnamts.fr/codif/bdm_it/index_presentation.php?p_site
Website accessed on 19-04-2010
Source of website
o National: non-profit
� l'Assurance Maladie - Securité Sociale
General information
o Country or organization behind the website
� France, National Health Insurance
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database, downloadable documents
o Languages available
� French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information X � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: site consists of 4 separate databases, each of them has an individual date of update and version count; * Site map/search: no site map available, but very useful search engine!! Searches possible by: CIP code, specialty (medicine name), other criteria (e.g. indication, active substance, route of administration, ATC, pharmaceutical form), therapeutic alternatives, prescription analysis, codification, downloading files and changes of the week/month; * Download/print version: no print version available, but download files available listing all reimbursable medicines, reimbursable medicines updated this week and a file with delisted medicines; * Author information: No disclosure of source and no contact information available, website only contains databases, no additional information; * Links: no useful links, nor links to other pricing websites; * Important note: 4 different databases available on website 1. Table Nationale de codage de Biologie (TNB) 2. Base de Données des Médicaments (BDM) 3. Base des Médicaments et Informations Tarifaires (BDM_IT) � database containing medicine prices
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 176
4. Liste des Produits et des Prestations (LPP) * Price types: manufacturer price, retail/patient price, reimbursement price (shown as % of retail price) France - Codage
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Price type X Actual price per box Quality X Pharmacopoeial specifications X
France- Codage Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size (20-100 tablets) Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
France - Codage Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Taxes & duties & other charges X VAT = 5.5%, 19.6% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 177
FRANCE
- http://medicprix.sante.gouv.fr/medicprix/welcome.do
Website accessed on 19-04-2010
Source of website
o National: non-profit
� Comité Economique des Produits de Santé (CEPS)
General information
o Country or organization behind the website
� France, Ministry of Health and Sports
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Clear layout: theme website specific for medicine prices, welcome screen is search box, results of search displayed in clear table; * Update: no information available on date of creation website, nor on last update of both website in general and database with price information; * Site map/search: useful search engine with advanced search option (search by INN name, brand name, manufacturer, generic medicine only); * Download/print version: both options are not available in the database; * Author information: disclosure of source and additional information on projects, but no direct contact information for database author (only contact information Ministry of Health in general); * Links: no useful links available on website, nor links to other pricing websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 178
* Additional information: http://medicprix.sante.gouv.fr/medicprix/glossaire.do Detailed glossary given on contents of database: Medicine: each identified by its name (brand name or INN name) and name of manufacturer; Pharmaceutical specialty: under one drug name there may be several dosage strengths and dosage forms listed of the active ingredient; Presentation: each of these pharmaceutical specialties may exist in one or more presentations depending on the quantity sold (e.g. number of tablets or volume of bottle); Manufacturer price: price excluding taxes, sale price to wholesalers; Retail price: price including all taxes; CIP: Code Inter Pharmaceutique, each medicine is associated with this identifier code (each brand, generic has a different code); Presentation type: generic, originator or 'princeps' (originator no longer patented) and generic substitutions shown; Prices and costs liability: for some generic groups CEPS sets a "Tariff of responsibility" (TFR), this is in addition to the price of the originator and generic products. The TFR is generally equal to the retail price, including all taxes, of generics. France - Comité Economique des Produits de Santé
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Price type X Actual price per box Quality X Pharmacopoeial specifications X
France - Comité Economique des Produits de Santé Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price includes all taxes
VAT 5.5% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 179
GERMANY
- http://www.dimdi.de/static/en/amg/fbag/index.htm
Website accessed on: 13-04-2010
Source of website
o National: non-profit
� Deutsche Institut für Medizinische Dokumentation und Information (DIMDI)
General information
o Country or organization behind the website
� Germany, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� downloadable Excel file
o Languages available
� German, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation X
No undesired advertisements X � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance X Last update price information X � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information X Search ability within price information X Download / print version price information X � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: website update every week, but last price update 01-04-2010; * Search: search engine available on website, but search by INN name not possible; * Search ability within prices: downloadable document, no search option within database; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both German and international websites, but no price reporting links;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 180
Germany Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Price per box Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT included, amount not
specified Price incl. co-payments X Reimbursed amount is ceiling
price (not always retail price) Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 181
HUNGARY
- http://cedd.oep.hu/
Website accessed on: 08-04-2010
Source of website
o National: non-profit
� National Health Insurance Fund Administration of Hungary
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-03-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the National Health Insurance Fund Administration of Hungary contributed and a link to their website, but no additional information or direct contact information for Hungarian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Hungarian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 182
Hungary Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = HUF 271.99
(adjustable on website dependent on date of access)
Date of price information X 02-03-2010 Price type X Quality X Pharmacopoeial specifications X Hungary
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = HUF 271.99
(adjustable on website to date of access)
Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X Hungary
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = HUF 271.99
(adjustable on website to date of access)
Date of price information X 02-03-2010 Taxes & duties & other charges X VAT = 5% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 183
IRELAND
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Irish Health Service Executive
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-01-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Irish Health Service Executive contributed and a link to their website, but no additional information or direct contact information for Hungarian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: all characteristics in English (national language); * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 184
Ireland Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size & unit size Volume X Pack size & unit size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-01-2010 Price type X Taxes & duties & other charges X (VAT oral 0%, other 21%)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 185
ITALY
- http://farmaco.agenziafarmaco.it/index.php
Website accessed on 28-04-2010
Source of website
o National: non-profit
� Agenzia Italiana del Farmaco (AIFA)
General information
o Country or organization behind the website
� Italy, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Italian, small selection in English (English corner)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings to access the AIFA website for patients & consumers, for health professionals, for pharmaceutical companies and a pressroom; * Update: no information on site updates or maintenance, mentioned above database search engine that prices are regularly updated but no date given; * Site map/search: both are available on website, search by INN name (Italian) possible but search results do not link to price database; additional feature: pull down tab specific for medicine news (INN name) gives some background information on INN name (ATC code, anatomical group, pharmaco-therapeutic subgroup, chemical subgroup, active ingredient, note from AIFA, links to other medicines in same (sub)groups); * Search within prices: possibility to search on INN name, product name and manufacturer, search results list brand name, active substance, ATC, reimbursement class/system, speed of delivery, retail price; * Download/print version: no print version nor download version available; * Author information: disclosure of source, but no specific contact information for author responsible for medicine pricing;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 186
* Links: useful links to Medicine Authorities in Europe per country and some international websites, but no price reporting links; Italy
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 10-20% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 187
LATVIA
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Latvian State Medicines Pricing and Reimbursement Agency
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-01-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Latvian State Medicines Pricing and Reimbursement Agency contributed and a link to their website, but no additional information or direct contact information for Latvian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Latvian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 188
Latvia Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = LVL 0.6990
(adjustable on website to date of access)
Date of price information X 02-01-2010 Price type X Taxes & duties & other charges X Latvia
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = LVL 0.6990
(adjustable on website to date of access)
Date of price information X 02-01-2010 Taxes & duties & other charges X VAT = 5% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 189
LITHUANIA
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Department of Pharmacy under the Ministry of Health of the Republic of Lithuania
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 20-02-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Department of Pharmacy under the Ministry of Health of the Republic of Lithuania contributed and a link to their website, but no additional information or direct contact information for Lithuanian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Lithuanian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 190
Lithuania Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = LTL 3.4528
(adjustable on website dependent on date of access)
Date of price information X 20-02-2008 Price type X Quality X Pharmacopoeial specifications X Lithuania
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = LTL 3.4528
(adjustable on website dependent on date of access)
Date of price information X 20-02-2008 Price type X Taxes & duties & other charges X Lithuania
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = LTL 3.4528
(adjustable on website dependent on date of access)
Date of price information X 20-02-2008 Taxes & duties & other charges X VAT = 5% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 191
NETHERLANDS
- www.medicijnkosten.nl
Website accessed on 15-04-2010
Source of website
o National: non-profit
� College voor Zorgverzekeringen (CVZ)
General information
o Country or organization behind the website
� the Netherlands, College for Health Insurances (NGO)
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Dutch
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 Update: no information on last update available for both site in general and price information nor date of creation (no dates mentioned on website); * Site map: only available on general website College for Health Insurances (CVZ) and does not include a site map of the medicine costs theme website; * Author information: disclosure of source, but contacts not specific for price information; * Links: no links to other websites, only links to theme websites of CVZ; * Important note: Medicijnkosten.nl is a theme site of the College for Health Insurances. Both have a different web link (www.cvz.nl) and a link to this general website is not easy to find. * Price information: Average prices based on average use during 15 days (filled in by patient) including VAT, excluding dispensing fee. * Dispensing fee: � standard dispense (1 to 3 month supply): fee is € 6.35 (up to a maximum of € 7.99) � weekly dispense: € 3.49 (up to a maximum of € 4.40) * Additional fees:
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 192
� first dispense: € 6.35 (up to a maximum of € 7.99) � dispense in the evening or on a Sunday (incl. holidays): € 12.69 (up to a maximum of € 15.98) � simple pharmacy preparation: € 12.69 (up to a maximum of € 15.98) � complex pharmacy preparation: € 95.17 (up to a maximum of € 119.91)
Netherlands
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price incl. co-payments X Difference between retail price
and reimbursed amount is co-payment
Price incl. dispensing fee X Not included Netherlands
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price incl. co-payments X Difference between retail price
and reimbursed amount is co-payment
Price incl. dispensing fee X Not included
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 193
NORWAY
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Norwegian Medicines Agency
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-07-2009; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Norwegian Medicines Agency contributed and a link to their website, but no additional information or direct contact information for Norwegian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Norwegian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 194
Norway – Common European Drug Database Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Pack size & unit size Exchange rate (if not national currency) X € 1.00 = NOK 9.4275
(adjustable on website to date of access)
Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X (VAT 25%) Norway – Common European Drug Database
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = NOK 9.4275
(adjustable on website to date of access)
Date of price information X 02-03-2010 Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 195
NORWAY
www.legemiddelverket.no/templates/InterPage____28315.aspx?filterBy=CopyToGeneral
Website accessed on 22-04-2010
Source of website
o National: non-profit
� Statens legemiddelverk
General information
o Country or organization behind the website
� Norway, Norwegian Medicines Agency
o Basis for access
� free to access, no registration
o Database or other format
� downloadable document with package prices (A-Z index on product name (originator
or generic brand))
o Languages available
� Norwegian, important documents in English (such as price information) but some
menu options only available in Norwegian
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites * Clear layout: website is divided into 5 sections: general information, consumer part, health professional part, pharmacies and wholesalers parts, and industries part (sections only available in Norwegian); * Update: no information available on last update of website in general, some topics on the website show a date of creation and last update but very irregular, price list with package prices is dated on 01-04-2010; * Site map/search: site map and search engine are both available on the website, search engine provides the option to search by INN name but the results don't link to the prices because they are only listed in a download document; * Search within prices: no search option within price document, A-Z listing on product name (not INN name); * Download/print version: download version (excel document) containing prices and additional
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 196
information per product, but no print version available on website; * Author information: disclosure of source, detailed information on Norwegian Medicines Agency and their projects and mission statement, and detailed contact information for each separate topic on the website (all contacts listed in a table); * Links: no useful links available on website, nor links to other pricing websites; * Additional pricing information: www.legemiddelverket.no/templates/InterPage____25641.aspx?filterBy=CopyToGeneral Pharmacy purchasing price (PPP): All prescription medicines must be given a maximum price, set by the Drug Administration, before they can be brought into commerce. The main rule when pricing a medicinal product in Norway is that it be set at the mean of the three lowest market prices of that product in a selection of countries. The basis of price comparisons is the actual market price in each of the individual countries in the price comparison group. This market price is defined as the price which the major part of the market pays for the product. If there is no price in three or more of the countries which are included in the price comparison group the price will usually be set at the mean price in the countries where a market price exists. The countries which are normally included in the price comparison group are: Sweden, Finland, Denmark, Germany, Great Britain, The Netherlands, Austria, Belgium and Ireland. The price which is set by the Norwegian Medicines Agency is the permitted maximum market price to the pharmacist (PPP). The product can be freely sold at a lower price than the maximum price. Pharmacy retail price (PRP): The maximum pharmacy purchasing price (PPP) plus the maximum pharmacy gross profit defines the value of the pharmacy retail price (PRP). Price and reimbursement overview: Please note that both the maximum pharmacy purchasing price (PPP) and the maximum pharmacy retail price (PRP) are maximum prices and that the real cost may therefore be lower than listed in the database. Exchange rates: Price comparison is based on the price in the local currency, converted to NOK. The mean exchange rate of the last six whole months, as presented by the Central Bank of Norway, is used as the basis for the comparison of prices. * The stepped price model: This model was introduced on 01-01-2005 to reduce the costs of the National Insurance and the patients, related to the use of generic drugs. The price of a medicine is reduced step by step by predefined rates. This occurs after the medicine has lost patent protection and has been exposed to generic competition. The model has been modified twice after its introduction to reduce prices. The last change was implemented 01-01-2008. * The stepped price: The stepped price is the maximum price reimbursed by the National Insurance. The maximum reimbursement price for a generic product is set as a percentage of the maximum retail price of the original pharmaceutical product (PRP) at the time it was exposed to generic competition. The reimbursement price is cut by two or three steps. The first price-cut takes place when generic competition arises. The second cut is implemented 6 months after generic competition has occurred. The third step is applicable 12 months or more after the time of the second step. The rates of reduction depend on the annual sale of the product and are described in the table below. The generic substance simvastatin is an exception and the price of this substance has been reduced by 85% after 6 months. * Obligations of the pharmacies and wholesalers: The pharmacies are obliged to secure the capacity to deliver at least one pharmaceutical product at a retail price equal to the stepped price. If a pharmaceutical product is delivered in both small and large packages, the pharmacy is obliged to deliver both small and large packages to a retail price equal to the stepped price. The wholesalers are obliged to offer the pharmacies pharmaceutical products that enable them to fulfill these obligations.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 197
Norway - Statens legemiddelverk Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Multiple pack size Exchange rate (if not national currency) NA NA Norwegian Krone (NOK) =
national currency Date of price information X 01-04-2010 Price type X Actual price list Taxes & duties & other charges X Norway - Statens legemiddelverk
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Exchange rate (if not national currency) NA NA Norwegian Krone (NOK) =
national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Difference between patient
price and reimbursed amount is co-payment
Price incl. dispensing fee X Norway - Statens legemiddelverk
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) X Norwegian Krone (NOK) =
national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Difference between patient
price and reimbursed amount is co-payment
Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 198
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 199
POLAND
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Polish Ministry of Health
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 17-07-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Polish Ministry of Health contributed and a link to their website, but no additional information or direct contact information for Polish price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Polish, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 200
Poland Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed,
manufacturer not listed Exchange rate (if not national currency) X € 1.00 = PLN 4.0777
(adjustable on website dependent on date of access)
Date of price information X 17-07-2008 Taxes & duties & other charges X VAT = 7% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 201
PORTUGAL
- www.infarmed.pt/infomed/inicio.php
Website accessed on 28-04-2010
Source of website
o National: non-profit
� Infarmed, Autoridade Nacional do Medicamento e Produtos de Saude
General information
o Country or organization behind the website
� Portugal, National Authority supervised by Ministry of Health
o Basis for access
� free to access, no registration (registration required for download of database)
o Database or other format
� searchable internet database
o Languages available
� Portuguese, English partly available
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings on main webpage for patients & consumers, for health professionals, for pharmacies & suppliers and for the industry; * Update: no information on date of price information or last update of price information; * Site map/search: search on INN name links to last update document with price information; * Download/print version: download version of search results available; * Author information: full disclosure of source, and direct contact information to all the different departments and teams within INFARMED; * Links: useful national, European, international links, but no to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 202
Portugal - Inicio Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between
reimbursement and patient price is co-payment
Price incl. dispensing fee X Portugal – Inicio
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 6%, included Price incl. co-payments X Difference between
reimbursement and patient price is co-payment
Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 203
PORTUGAL
- www.infarmed.pt/genericos/menu.html
Website accessed on 28-04-2010
Source of website
o National: non-profit
� Infarmed, Autoridade Nacional do Medicamento e Produtos de Saude
General information
o Country or organization behind the website
� Portugal, National Authority supervised by Ministry of Health
o Basis for access
� free to access, no registration (registration required for download of database)
o Database or other format
� searchable internet database
o Languages available
� Portuguese, English partly available
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings on main webpage for patients & consumers, for health professionals, for pharmacies & suppliers and for the industry; * Update: last update of price information 29-03-2010, website in general weekly updated; * Site map/search: search on INN name links to last update document with price information; * Search within prices: search options by INN name, by therapeutic group, by pharmaco-therapeutic subgroup or complete list of all generic drugs available (A-Z index); * Download/print version: no download version nor print version of price information available; * Author information: full disclosure of source, and direct contact information to all the different departments and teams within INFARMED; * Links: useful national, European, international links, but no to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 204
Portugal - Genericos Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 29-03-2010 Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between
reimbursement and patient price is co-payment
Price incl. dispensing fee X Portugal - Genericos
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 29-03-2010 Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between
reimbursement and patient price is co-payment
Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 205
SLOVAKIA
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Slovakian Ministry of Health
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 30-09-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Slovakian Ministry of Health contributed and a link to their website, but no additional information or direct contact information for Slovakian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Slovakian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 206
Slovakia Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = SKK 30.30
(adjustable on website dependent on date of access)
Date of price information X 30-09-2008 Price type X Quality X Pharmacopoeial specifications X Slovakia
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,
manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = SKK 30.30
(adjustable on website dependent on date of access)
Date of price information X 30-09-2008 Taxes & duties & other charges X VAT = 10% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 207
SLOVENIA
- http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Slovenian Health Insurance Institute
General information
o Country or organization behind the website
� Hungary, National Health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 10-12-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Slovenian Health Insurance Institute contributed and a link to their website, but no additional information or direct contact information for Slovenian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Slovenian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 208
Slovenia Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Brand name listed,
manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X Euro (€) = national currency Date of price information X 10-12-2008 Price type X Taxes & duties & other charges X (VAT = 8.5%)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 209
SPAIN
- https://sinaem4.agemed.es/consaem/fichasTecnicas.do
Website accessed on 26-04-2010
Source of website
o National: non-profit
� Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)
General information
o Country or organization behind the website
� Spain, Ministry of Health and Social Policies
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Spanish, partly in English (only headings translated, results and additional info in
Spanish)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of general website AEMPS, last update website containing database with price information is 20-07-2009; * Site map/search: site map is available on website, search engine provides option to search by INN name (only in Spanish) but does not link to documents with price information; * Search within prices: search options by INN name, brand name, national code, authorization number, manufacturer, therapeutic group, but searches only possible in Spanish terms; * Download/print version: no print version available, but search results can be exported to 4 different formats (csv, excel, xml, pdf); * Author information: full disclosure of source (AEMPS in general) and contact information to contact author price information directly available; * Links: useful national and international links available (Medicine Evaluation Agencies (national, European and international), Institutions on health (national and international), groups of interest (national and international sites on health topics), but no links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 210
Spain - Agencia Española de Medicamentos y Productos Sanitarios
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 20-07-2009 Taxes & duties & other charges X VAT = 16% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 211
SPAIN
- http://www.vademecum.es/
Website accessed on 27-04-2010
Source of website
o National: non-profit
� Vademecum.es
General information
o Country or organization behind the website
� Spain, United Business Media Medica Spain (UBM Medica Spain)
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Spanish
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 1
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Undesired advertisements: newsfeeds from governmental sites, vademecum itself but also from pharmaceutical companies and some health-related organizations, these banners could distract users from the most important content on the website; * Update: last update of website in general 26-04-2010 but no information on last update of database containing price information; * Site map/search: site map is available on website, search engine provides option to search by INN name (only in Spanish) but does not link to documents with price information; * Search within prices: search options by INN name (search term or A-Z index), brand name (search term or A-Z index), manufacturer, therapeutic group (disease & symptoms), but searches only possible in Spanish terms; * Download/print version: print version available of search results and search results can be shared with others by emailing them; * Author information: full disclosure of source (legal notice) UBM Medica Spain and contact information to contact author price information directly available (select department); * Links: links to national health related websites, but no links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 212
Spain - Vademecum
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume listed (1 pack) INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Price type X Manufacturer selling price Quality X Pharmacopoeial specifications X Spain- Vademecum
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 16% Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 213
SWEDEN
- www.tlv.se/in-english/price-database/
Website accessed on 28-04-2010
Source of website
o National: non-profit
� Tanvårds- och Läkemedelsförmånsverket (TLV)
General information
o Country or organization behind the website
� Sweden, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� Swedish, English (database with medicine prices not in English)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of website in general, price information last updated on 26-04-2010 (monthly price lists with cheapest products); * Site map/search: both are present on website, searches on general website by INN name provide results with additional information in background documents, but also a specific link saying how many hits are found in the pricing database (direct access link); * Search within prices: search option by INN name, drug name, manufacturer, ATC code; additional feature: in Excel document all characteristics displayed can be changed individually (e.g. only display amoxicillin, only display reimbursed medicines, only display generics, …); * Download/print version: search results alone or complete database can be exported into excel file and search results can be printed; * Author information: disclosure of background information on DLV, but no specific contact information for author of database (only general TLV contact); * Links: useful links to national and some international websites, but no links to other price reporting websites; * Additional information: because the database is only available in Swedish a glossary in English
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 214
is displayed on the website: • Produkt = Product • Form = Dosage form • Styrka = Strength • Storlek = Size • AIP (Apotekets inköpspris) = AIP (Pharmacy Wholesale Price) • Pris = Price (Skr) • Sub = Reimbursed • Företag = Company • ATC-kod = ATC code • Varunr = Product number • Begränsning av subvention = Restriction of reimbursement
* Important note: In Sweden the government subsidizes medicines so that everyone has access to good and effective medicines. However, not all medicines are subsidized; one of the tasks of TLV is to determine which medicines should be subsidized. To get the patients a discount another 4 criteria need to be fulfilled. The medicine should:
1. be written on a prescription; 2. aim to prevent, diagnose, treat or cure a disease, or symptoms of a disease in a human; 3. be prescribed by a person authorized to do so (licensed); 4. be on a recipe with a "working-place-code"
Sweden - Pharmacy Wholesale Price
Wholesaler price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Price per packsize Exchange rate (if not national currency) NA NA Swedish Krone (SEK) =
national currency Date of price information X 26-04-2010 Price type X Actual price list Taxes & duties & other charges X Sweden – Patient Price
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Swedish Krone (SEK) =
national currency Date of price information X 26-04-2010 Taxes & duties & other charges X Excl. VAT Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 215
UNITED KINGDOM
http://www.cmu.nhs.uk/Medicines/Generic/Pages/eMIT.aspx
Website accessed on 28-04-2010
Source of website
o National: non-profit
� National Health Service Commercial Medicines Unit (NHS CMU): Generic
Pharmaceuticals electronic Market Information Tool (eMIT)
General information
o Country or organization behind the website
� United Kingdom, Ministry of Health
o Basis for access
� free to access, no registration
o Database or other format
� downloadable excel database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance X Last update price information X � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 0
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website but date of creation website is January 2010, excel file with price information is version April 2010; * Site map/search: no site map available on website, search engine provides advanced search option, search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: pull down within excel tab to select medicine and its price (A-Z index on INN name (generic medicines only)); * Download/print version: download version available, but no print version; * Speed to search page: download time at 56K is 131.6 seconds; * Author information: disclosure of source, additional background information on eMIT and specific contact information for prices author available; * Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; * Background information: The data provided in eMIT includes an estimate of NHS hospital-sector
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 216
annual usage from English trusts for the product selected, the average (weighted arithmetic mean) price paid for that product over the last four months of the period and a measure of the variance of that average. The estimates provided are derived from data collected via NHS CMU's PharmEx system (covering ca. 95% of the constituent NHS trusts) representing the 12 month period to end September 2009. United Kingdom - Generic Pharmaceuticals electronic Market Information Tool
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X Pack size listed INCO term X Supplier X Volume purchased X Price per pack Purchase terms X Payment terms / timelines X Date of price information X 04-2010 Date of procurement award X Exchange rate at time of award NA NA English Pound (£) = national
currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Excl. VAT
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 217
UNITED KINGDOM
http://www.dmd.nhs.uk/dictionary
Website accessed on 28-10-2010
Source of website
o National: non-profit
National Health Service Dictionary of Medicines and Devices (NHS DM+D)
General information
o Country or organization behind the website
� United Kingdom, Ministry of Health
o Data supplier
� NHS Prescription Services of the NHS Business Services Authority (NHSBSA)
o Basis for access
� free to access, no registration
o Database or other format
� online database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information X � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website, price information updated monthly; * Site map/search: no site map available on website, search engine provides search by INN name; * Search within prices: search on INN name, possibility to select different dosage forms and manufacturers and variable pack sizes; * Download/print version: download version available after registration, but no print version; * Speed to search page: download time at 56K is 131.6 seconds; * Author information: disclosure of source, additional background information on DMD and specific contact information for prices author available; * Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; Additional information: The dm+d dictionary contains unique identifiers and associated textual
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 218
descriptions for medicines and medical devices. It is to become the NHS standard for medicines and device identification, ensuring safe and reliable exchange of information on medicines and devices. United Kingdom – NHS Dictionary of Medicines and Devices
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Yes, if not generic product Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national
currency Date of price information X 11-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 219
UNITED KINGDOM
- http://www.isdscotland.org/isd/2246.html
Website accessed on 28-04-2010
Source of website
o National: non-profit
� Scottish Drug Tariff
General information
o Country or organization behind the website
� Scottish Government, Information Services Division (ISD Scotland)
o Basis for access
� free to access, no registration
o Database or other format
� downloadable Excel document
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: Last update website on National Drug Tariff 31-03-2010, last version price information is 01-04-2010; * Site map/search: both are available on the website, search on site mastered by Google; * Search within prices: database only available in downloadable excel document, A-Z listing on INN name, no search option within document; * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on ISD Scotland and on National Drug Tariff, direct contact information to prices author listed underneath download link database; * Links: useful national and international links, including links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 220
United Kingdom - Scottish Drug Tariff
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national
currency Date of price information X 01-04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 221
UNITED KINGDOM
- http://www.ppa.org.uk/ppa/edt_intro.htm
Website accessed on 28-04-2010
Source of website
o National: non-profit
� National Health Service Drug Tariff for England and Wales (NHS)
General information
o Country or organization behind the website
� United Kingdom, Ministry of Health
o Data supplier
� NHS Prescription Services of the NHS Business Services Authority (NHSBSA)
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website, price database is dated 01-05-2010 (monthly updated database); * Site map/search: no site map available on website, search engine provides advanced search option, search by INN name possible, however this mainly shows background materials and no links to current price information; * Search within prices: database containing price information can be arranged by contents (different chapters per topic), index (A-Z listing of pharmaceutical products) or a search box can be used to find specific information immediately; * Download/print version: download version not available (online database), but print versions available (complete database, specific chapter or search results); * Author information: disclosure of source, additional background information on Electronic Drug Tariff and specific contact information for prices author available;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 222
* Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; * Professional fees (Pharmacy contractors): - all prescriptions attract a professional fee with a value of £ 0,90 United Kingdom - Drug Tariff for England and Wales
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Yes, if not generic product Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national
currency Date of price information X 01-05-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Not included
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 223
UNITED KINGDOM
- http://bnf.org/bnf/index.htm
Website accessed on 28-04-2010
Source of website
o National: non-profit
� British National Formulary (BNF)
General information
o Country or organization behind the website
� United Kingdom,
o Basis for access
� registration required, free to access for residents of the UK and some developing
countries (list on website)
o Database or other format
� access after payment
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 0 1 Accessibility of information
Number of clicks to access price information Search ability within price information Download / print version price information � Combined score accessibility of information 0 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website; latest version BNF is March 2010; * Site map/search: no site map available on website, search by INN name possible, however this only shows background materials and no links to price information; * Basis for access: registration required, free to access for residents of the UK and some developing countries (list on website), other countries need a subscription to access; * Search within prices: * Download/print version: download version available, but no print version; * Author information: disclosure of source, additional background information on BNF and specific contact information for prices author available; * Links: no useful links and no links to price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 224
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 225
ANNEX VIII Qualitative Country Annex
South East Asia Regional Office (SEARO)
INDIA
- www.nppaindia.nic.in/index1.html
Website accessed on: 21-04-2010
Source of website
o National: non-profit
� National Pharmaceutical Pricing Authority (NPPA)
General information
o Country or organization behind the website
� India, Ministry of Chemicals and Fertilizers: Department of Pharmaceuticals
o Basis for access
� free to access, no registration
o Database or other format
� downloadable document (prices of bulk drugs) & online database (ceiling prices of
scheduled formulations)
o Languages available
� English, Hindi
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of website in general, last update price information in database link on 15-05-2008, some prices reviewed on 16-04-2010 but no changes made in pricing document (yet); * Site map/search: site map available on website, search engine provides search on INN name and search results link to pricing documents; * Search within prices: database and document listed as an A-Z index by INN name, no search option within price list; * Download/print version: download version of both price lists available but no direct print version; * Author information: background information on NPPA and Drugs Prices Control Order (DPCO),
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 226
no specific contact information for prices author; * Links: useful links to related Departments within the Ministry and to Ministries of Health of other countries, but no links to other price reporting sites; * Additional information: The retail price of a formulation shall be calculated by the Government in accordance with the following formula namely: R.P. = (M.C. + C.C. + P.M. + P.C.) x (1 + MAPE/100) + ED. where
• "R.P." means retail price; • "M.C." means material cost and includes the cost of drugs and other pharmaceutical aids
used including overages, if any, plus process loss thereon specified as a norm from time to time by notification in the Official Gazette in this behalf;
• "C.C." means conversion cost worked out in accordance with established procedures of costing and shall be fixed as a norm every year by notification in the Official Gazette in this behalf;
• "P.M." means cost of the packing material used in the packing of concerned formulation, including process loss, and shall be fixed as a norm every year by, notification in the Official Gazette in this behalf;
• "P.C." means packing charges worked out in accordance with established procedures of costing and shall be fixed as a norm every year by notification in the Official Gazette in this behalf;
• "MAPE" (Maximum Allowable Post-manufacturing Expenses) means all costs incurred by a manufacturer from the stage of ex-factory cost to retailing and includes trade margin and margin for the manufacturer and it shall not exceed one hundred per cent for indigenously manufactured Scheduled formulations;
• "E.D." means excise duty: Provided that in the case of an imported formulation, the landed cost shall form the basis for fixing its price along with such margin to cover selling and distribution expenses including interest and importer's profit which shall not exceed fifty percent of the landed cost.
India - National Pharmaceutical Pricing Authority
Retail / Patient price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Indian Rupee (INR/Rs) =
national currency Date of price information X 15 / 05 / 2008 Taxes & duties & other charges X Maximum ceiling prices exclusive of
excise duty and local taxes Price incl. co-payments X Price incl. dispensing fee X Maximum ceiling prices exclusive of
excise duty and local taxes
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 227
INDIA
- http://www.tnmsc.com/tnmsc/new/html/services.php#
Website accessed on: 21-04-2010
Source of website
o National: non-profit
� Tamil Nadu Medical Services Corporation Ltd. (TNMSC)
General information
o Country or organization behind the website
� India, Government - Health & Family Welfare Department
o Basis for access
� free to access, no registration
o Database or other format
� downloadable document with finalized rates and suppliers
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, last update price information 30-04-2010, new list for tender valid from this date (2010-2011); * Site map/search: no site map, nor search engine available on website; * Search within prices: prices only available in downloadable document, no search option within document, listing on product number (random alphabetical order); * Download/print version: download version of price list but no direct print version available; * Author information: background information on TNMSC in general and on their procurement services, but no specific contact information for prices author; * Links: no useful links nor links to other price reporting sites on website;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 228
India - Tamil Nadu Medical Services Corporation Ltd.
Procurement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Only generics, all listed on INN name Packaging specifications & size X Unit (box, bottle, ampul) INCO term X Supplier X Supplier listed for each medicine
(Name of the tenderer) Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Tender contract 2010-2011 Date of procurement award X Exchange rate at time of award NA NA Indian Rupee (INR/Rs) =
national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X All prices are exclusive of taxes
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 229
ANNEX IX Qualitative Country Annex
Western Pacific Regional Office (WPRO)
AUSTRALIA
- www.pbs.gov.au
Website accessed on 06-04-2010
Source of website
o National: non-profit
� Pharmaceutical Benefits Scheme
General information
o Country or organization behind the website
� Australia, government: Department of Health and Ageing
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation X
No undesired advertisements X � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different versions of the PBS for consumers, for health professionals, for industry; * Update: Site & price update reported on website (01-04-2010), latest news feed shows PBS Website Update and documents with detailed information on changes made; * Links: useful links to Australian health related websites, but none to price reporting websites; * Current patient fees & charges: http://www.pbs.gov.au/html/consumer/pbs/about � Patient co-payments: from 01-01-2010 patients pay up to $33.30 (Australian Dollars) for most PBS medicines or $5.40 if they have a concession card. The Australian Government pays the remaining cost. The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 230
� Safety Net: from 01-01-2010, the Safety Net threshold is $324.00 for concession card holders and $1,281.30 for all other patients. After reaching this threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals – this is called the joint Safety Net. From 1-01-2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. � Price below general patient co-payment: For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may then charge the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine. The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards a patient's Safety Net threshold. � Additional fee for ready prepared items: In addition, if a medicine has a ‘dispensed price for maximum quantity’ less than the general co-payment a safety net recording fee may be charged by the pharmacist. This fee may not take the cost of the script above the co-payment. This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards a patient's Safety Net threshold. � Price premium: A price premium or brand premium, may apply to some medicines. Where there are two or more brands of the same drug on the Schedule, the Government subsidizes each brand to the same amount - up to the cost of the lowest priced brand. If a patient takes a more expensive brand the price difference is paid by the patient as a brand premium. This cost is in addition to co-payment. Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the Safety Net threshold. Australia
Reimbursement price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed, manufacturer
is not listed Packaging specifications & size X Exchange rate (if not national currency) NA NA Australian dollar (AU$) =
National currency Date of price information X 01/04/2010 Taxes & duties & other charges X GST = 10%, unknown if it is
included or not Price incl. co-payments X Amount paid by government,
maximum paid by patient and reimbursed amount listed
Price incl. dispensing fee X Pharmacist fee, amount not specified
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 231
NEW ZEALAND
- www.pharmac.govt.nz
Website accessed on 06-04-2010
Source of website
o National: non-profit
� Pharmaceutical Management Agency
General information
o Country or organization behind the website
� New Zealand, Pharmaceutical Management Agency
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database and downloadable database file
o Languages available
� English, Maori (partly)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation X
No undesired advertisements X � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance X Last update price information X � Combined score update 2
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1,7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings to access the Pharmaceutical Schedule for patients & consumers, for health professionals, for district health boards, for pharmaceutical suppliers; * Update: both site in general and price information updated once every month; * Site map: last update 13-11-2008, site last updated in 04-2010; * Download/print: only a download version of the database is available; * Author information: disclosure of source and contact information specific for pricing author; * Links: some useful links (not clearly labeled), no price reporting links;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 232
New Zealand Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Brand name & manufacturer X Brand name or generic name listed Packaging specifications & size X Price per amount (tablets,
capsules, milliliter) INCO term X Exchange rate (if not national currency) NA NA New Zealand dollar (NZ$) =
National currency Date of price information X 05-2010 Price type X Quality X Pharmacopoeial specifications X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 233
ANNEX X Qualitative Price Guides Annex
Global Fund to fight AIDS, Tuberculosis and Malaria
& AIDS Medicines and Diagnostic Services
Global Fund to fight AIDS, Tuberculosis and Malaria
http://www.theglobalfund.org/en/procurement/pqr/
Website accessed on 29-04-2010
Source of website
o International: non-profit
� The Global Fund: Price & Quality Reporting (PQR)
General information
o Country or organization behind the website
� The Global Fund
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database (product catalogue)
o Languages available
� English, Spanish, French, Chinese, Russian
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website Global Fund but date of copyright 2010, prices dated 01-2002 to 05-2010; * Site map/search: site map on website available in different version depending on user, search by INN name possible (only ARV), search results are background information, news events but no links to most recent prices; * Search within prices: price list online available, search by purchase order date, invoice date, last modified date, INCO term or therapeutic category; search results are A-Z listed on INN name; * Download/print version: prices online available, option to print or export search results or
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 234
complete database; * Author information: detailed background information on The Global Fund and on Price & Quality Reporting including direct contact information to PCR author; * Links: some useful links and a link to Global Price Reporting Mechanism of WHO; The Global Fund: Price & Quality Reporting
Wholesaler price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X Volume X Exchange rate (if not national currency) NA NA Prices in US$ Date of price information X Tender contract 01-01-2002 to
03-05-2010 Price type X High/low/mean price Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 235
AIDS Medicines and Diagnostic Services
- http://www.who.int/hiv/amds/gprm/en/index.html
Website accessed on 29-04-2010
Source of website
o International: non-profit
� Global Price Reporting Mechanism (GPRM)
General information
o Country or organization behind the website
� World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website but date of copyright 2010, last version GPRM report dated on November 2009, order data vary from years ago (2006) until February 2010; * Site map/search: site map not available on website, search by INN name possible, search results are background information, news events and links to most recent prices in reports; * Search within prices: price information online available, search by therapeutic category, INN name, strength, search by country or region or revenue category, dosage form, name and country of manufacturer, grant number, purchase order date (since / until option); search results are A-Z listed on country that purchased order; * Download/print version: prices online available, option to export database or search results into pdf or excel file, no direct print option; * Author information: detailed background information on Global Price Reporting Mechanism and contact information of AMDS (AIDS Medicines and Diagnostics Service) listed, but no contact information of database author; * Links: some useful links to other departments working on HIV/AIDS but no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 236
AMDS - Global Price Reporting Mechanism
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Generic & country of origin &
manufacturer Packaging specifications & size X INCO term X + shipment method Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Date of purchase order Date of procurement award X Exchange rate at time of award NA NA Prices in US $ Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 237
ANNEX XI Qualitative Price Guides Annex
Clinton Foundation & Médecins Sans Frontières
Clinton Foundation
http://www.clintonfoundation.org/what-we-do/clinton-health-access-initiative/information-
center-resources
Website accessed on 29-04-2010
Source of website
o International: non-profit
� Clinton Health Access Initiative (CHAI): Antiretroviral (ARV) price list
General information
o Country or organization behind the website
� Clinton Foundation
o Basis for access
� free to access, no registration
o Database or other format
� download version pricelist
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update website, last update price list April 2010; * Site map/search: site map on website, search by INN name possible (only ARV), search results are background information, news events and links to most recent and previous price list; * Search within prices: price list only available in downloadable pdf document, no search option within document, 2 categories (adult products, pediatric products), A-Z listing on INN name; * Download/print version: download version of price list, but no direct print version available; * Author information: detailed background information on Clinton Foundation and its projects and initiatives including CHAI, but no direct contact information to CHAI listed; * Links: no useful links nor links to other price reporting sites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 238
http://www.clintonfoundation.org/files/chai_arv_priceList_april2010_english.pdf * CHAI: The Clinton Health Access Initiative (CHAI) supports national governments to expand high-quality care and treatment to people living with HIV/AIDS. CHAI offers reduced prices for antiretrovirals (ARVs) to members of its Procurement Consortium. * Price agreements: CHAI has agreements with seven manufacturers: Aurobindo Pharma, Cipla Ltd., Hetero Drugs, Macleods Pharmaceuticals, Matrix Laboratories, Ranbaxy Laboratories and Strides Arcolabs. The ARVs included in CHAI’s pricing agreements are: abacavir (ABC), atazanavir (ATV), efavirenz (EFV), emtricitabine (FTC), lamivudine (3TC), lopinavir/ritonavir (LPV/r), nevirapine (NVP), stavudine (d4T), tenofovir (TDF) and zidovudine (AZT). Prices listed below are available to countries participating in the CHAI Procurement Consortium, which currently includes over 70 nations. These prices apply to procurements by national governments that are members of the CHAI Procurement Consortium, or organizations procuring on behalf of member governments, to support public care and treatment programs. * CHAI prices: CHAI prices represent price ceilings at or below which the indicated suppliers must price their products when selling or communicating price quotes for the specified products to members of the CHAI Procurement Consortium. In establishing price ceilings, CHAI aims to offer the lowest available prices to Consortium members while ensuring that products are available from more than one partner supplier wherever possible. * Per person per year prices: for pediatric formulations these prices are determined based on the recommended daily dosing for a 10 kg child (unless a formulation is not recommended for a 10kg child, then the annual price is calculated based on dosing for an applicable weight band). * Inco term: Prices listed are FCA Airport from the point of export FCA (Free Carrier) - The seller is responsible for arranging transportation, but acting at the risk and the expense of the buyer. The seller chooses and works with the freight forwarder or the carrier. Delivery is accomplished at a predetermined port or destination point and the buyer is responsible for insurance. * Quality: CHAI is committed to the sustainable supply of high-quality ARVs, consistent with the specifications of dossiers approved by the World Health Organization (WHO) Prequalification Programme, U.S. Food and Drug Administration (U.S. FDA), a stringent regulatory authority (SRA) as defined by the International Conference on Harmonization (ICH) or recommended for procurement by Expert Review Panel (ERP) of The Global Fund. Clinton Foundation
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Antiretroviral abbreviations Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X INCO term X FCA = free carrier Supplier X 7 supplier contracts Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 04-2010 contract Date of procurement award X Exchange rate at time of award X Quality X WHO / FDA / SRA Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 239
Médecins Sans Frontières (Doctors Without Borders)
http://utw.msfaccess.org/
Website accessed on 29-04-2010
Source of website
o International: non-profit
� MSF Campaogn for Access to Essential Medicines
General information
o Country or organization behind the website
� Médecins Sans Frontières (MSF)
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0.5
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 2
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website, database with prices last updated 22-02-2010; * Site map/search: no site map, nor search engine available on website; * Search within prices: view summary table of all medicine prices or search prices by therapeutic class, INN name (A-Z list to choose from) or manufacturer name (A-Z list to choose from); * Download/print version: prices online available, a tab exists on each drug page to print individul pages and every year there is a paper version which can be downloaded; * Author information: detailed background information on HIV/AIDS treatment and work done by MSF so far and new projects and goals, contact information specific for MSF Campaign for Access to Essential Medicines listed on main page; * Links: some useful links to other organizations working on HIV/AIDS, links on price resources are available on Annex 11 and each reference has an individual link, but no links to other price reporting websites; General information: General information on the history of the product and relevant WHO guidance is provided for each of the antiretrovirals (ARVs) included in this publication.15, 16 Separate profiles are
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 240
included for both single ARVs and fixed-dose combinations (FDCs) containing two or three ARVs. Table 1: Prices quoted by companies for eligible developing countries All prices are quoted in United States Dollars (US$). Currency conversions were made on the day the price information was received using the currency converter site www.oanda.com. Prices are rounded up to the third decimal for unit price and to the nearest whole number for yearly price per patient. The annual cost of treatment per patient year (ppy) has been calculated according to the WHO dosing schedules, multiplying the unit price (one tablet, capsule or millilitre) by the number of units required for the daily dose, and by 365. The price of the smallest unit is included in brackets. Where no WHO guidelines exist for a product, the dosage used is the U.S. FDA approved dosage. For paediatric treatments, prices are calculated for a 10kg child using recommended dosing based on weight bands, as it appears in the WHO treatment guidelines.16 This is an estimate, as the weight of a child increases during any given year. When it was not possible to calculate the dose for a 10kg child, only the unit price is indicated. For paediatric FDCs, the dosages used for the calculation are those recommended by the Paediatric Antiretroviral Working Group at WHO. The Clinton Foundation’s HIV/AIDS Initiative negotiates with several manufacturers for reduced prices for over 40 different ARV formulations for countries in their pooled procurement consortium. Manufacturers who have a product included in the most recent price announcement are indicated by a (CF) in the header of the table. Médecins Sans Frontières
Ex-factory price YES NO SPECIFICATIONS
INN name & dosage form & strength X Antiretroviral abbreviations Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X INCO term X FCA = free carrier Exchange rate (if not national currency) NA NA Prices in US$ Date of price information X Last update 22-02-2010 Price type X Average selling price Quality X Products included in the List of
Prequalified Medicinal Products (as of April 2010), including the ones approved by Health Canada, the European Medicines Agency (EMA) or (tentatively) approved by U.S. FDA, appear in bold in the tables of drug prices.
Pharmacopoeial specifications X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 241
ANNEX XII Qualitative Price Guides Annex
Common European Drug Database, Management Sciences for Health &
Österreichisches Bundesinstitut für Gesundheitswesen
Common European Drug Database
http://cedd.oep.hu/
Website accessed on 08-04-2010
Source of website
o National: non-profit
� Main Association of Austrian Social Security Institutions, State Institute of Drug
Control of the Czech Republic, Finnish Ministry of Social Affairs and Health, National
Health Insurance Fund Administration of Hungary, Irish Health Service Executive,
Latvian State Medicines Pricing and Reimbursement Agency, Department of Pharmacy
under the Ministry of Health of the Republic of Lithuania, Norwegian Medicines Agency,
Polish Ministry of Health, Slovakian Ministry of Health, Slovenian Health Insurance
Institute
General information
o Country or organization behind the website
� Hungary, National health Insurance Fund Administration of Hungary
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x x � Combined score update 0 / 0.5
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 242
Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price updates vary between countries (01-03-2010 to 20-02-2008) (see country specific tables); * Site map / Search: both give the option to search by country or by ATC code; * Author information: Disclosure of source is an introduction on the CEDD project and participating countries, direct contact information to CEDD author in National Health Insurance Fund Administration of Hungary; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in national language, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website cedd.oep.hu; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP. SEE COUNTRY ANNEXES FOR PRICE QUALITY CHARACTERISTICS
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 243
Management Sciences for Health
http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English
Website accessed on 30-04-2010
Source of website
o International: non-profit
� International Drug Price Indicator Guide
General information
o Country or organization behind the website
� Management Sciences for Health
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database (product catalogue)
o Languages available
� English, French, Spanish
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.7
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website, all price data is from 2008; * Site map/search: no site map available on website, search by INN name possible and search results link to most recent prices; * Search within prices: online database with prices, searches possible on INN name, by letter (A-Z) or by WHO EML Therapeutic Class; price data is from at least 5 suppliers and 5 buyers; * Download/print version: prices online available, option to download complete database in pdf format but no direct print option; * Author information: detailed background information on The Price Guide and contact information for MSH, but no direct contact information for prices author; * Links: some useful links and links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 244
Management Sciences for Health Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Details per supplier Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2008 Date of procurement award X Exchange rate at time of award X Quality X Data notes for 2008 Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 245
Österreichisches Bundesinstitut für Gesundheitswesen
http://www.goeg.at/en/PPI
Website accessed on 30-04-2010
Source of website
o International: non-profit
� Pharma Price Information
General information
o Country or organization behind the website
� Österreichisches BundesInstitut für Gesündheidswesen (ÖBIG)
o Basis for access
� fee to be paid to access price information
o Database or other format
� access to query results upon request and payment (no internet database)
o Languages available
� German, English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information ? ? ? � Combined score update 0 1 2
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 0 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 1
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website, but price queries on request (always most recent data available, so update gets a high score); * Site map/search: no site map, search engine on website but no search on INN name possible; * Search within prices: PPI queries carried out on INN name, ATC code, strength, dosage form per price type (manufacturer, wholesale, retail), therefore probably easy to search within prices; * Download/print version: no option to print or download price information (only after payment); * Author information: detailed background information on ÖBIG and PPI and specific contact information for PPI authors listed on website; * Links: no useful links, nor links to other price reporting websites; Pharma Price Information GÖG/ÖBIG’s Pharma Price Information service (PPI), upon request, provides quick, reliable and independent information on pharmaceutical prices in all member states of the EU, in Switzerland and in Norway.
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 246
Within Europe, pharmaceutical prices vary to a great extent. Despite a common currency – the euro – a comparison of prices is difficult and requires considerable resources and knowledge. We offer up-to-date price information that permits comparison at European level and we carry out comprehensive price comparisons to make cost-containment options visible. Standard query: you are interested in the market availability or the prices of a pharmaceutical product of a certain manufacturer/distributor. For carrying out the required research, we need a written enquiry that names the speciality in question (trade name, market authorisation holder), the desired strength (e.g., 20 mg) or pharmaceutical form as well as the desired price type (manufacturer’s price, pharmacy purchasing price, pharmacy retail price incl./excl. VAT) and the respective countries. Special query: you are interested in the prices of all pharmaceuticals with a certain active ingredient (brands, generics, parallel imports, etc.). For carrying out the required research, we need a written enquiry that names the active ingredient, the ATC code (if available) as well as the desired strength (e.g., 20 mg) or pharmaceutical form as well as the desired price type (manufacturer’s price, pharmacy purchasing price, pharmacy retail price incl./excl. VAT) and the respective countries. Example price of a PPI standard query: EUR 70 (excl. VAT) for one product, two strengths, one pharmaceutical form, all pack sizes, per country. Do not hesitate to contact us for customised price information according to individual needs that are not covered by our standard and special query services. MEDICINE PRICE INFORMATION NOT FREE TO ACCESS
NO DETAILS ON PRICE TYPES PROVIDED AND PRICE QUALITY CHARACTERISTICS
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 247
ANNEX XIII Qualitative Price Guides Annex
International Trade Centre, WHO databases, Health Action International &
UNICEF
International Trade Centre
http://www.intracen.org/market-news Website accessed on 30-04-2010
Source of website
o International: non-profit
� The Market News Service for Pharmaceutical Starting Materials (MNS report)
General information
o Country or organization behind the website
� International Trade Centre
o Basis for access
�
� Developing countries(including sub-Saharan Africa): free access to all MNS reports
� Developed countries: subscription fee required to access one or all MNS reports
o Database or other format
� downloadable version of MNS report, hardcopy available upon request
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 1.5
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 0 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website ITC but date of creation 2010 (new website), prices dated April 2010 (bimonthly report on Pharmaceutical Starting Materials); * Site map/search: no site map on website, search by INN name possible, search results are background information, news events and link to (sample) MNS report; * Basis for access: free access to bimonthly report on pharmaceutical starting materials (ingredients) for users from developing countries (list on website), users from developed countries
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 248
need a subscription to access reports (US$ 400 per sector); * Search within prices: price information only available in downloadable document and no search option within this document, medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on MNS and ITC, general contact information for ITC listed, form needs to be filled in to contact MNS team, no specific form for author price report on pharmaceuticals, however list of price information providers listed at the end of the MNS report; * Links: list of quick links within website, some useful links, but no links to other price reporting websites; MEDICINE PRICE INFORMATION NOT FREE TO ACCESS
NO DETAILS ON PRICE TYPES PROVIDED AND PRICE QUALITY CHARACTERISTICS
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 249
WHO databases
World Health Organization AFRO
http://www.afro.who.int/en/divisions-a-programmes/dsd/essential-medicines.html
Website accessed on 27-04-2010
Source of website
o International: non-profit
� Essential Medicines Price Indicator
General information
o Country or organization behind the website
� World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� downloadable pdf document
o Languages available
� English, French (not price document), Portuguese (not price document)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 2 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website and date of copyright 2009, information on prices dated on September 2007; * Site map/search: site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Essential Medicines and contact information of WHO AFRO and agencies that provide price information, but not all contact information is still correct (2007 version); * Links: some useful links to other organizations working on essential medicines and to other WHO websites and links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 250
All prices have been converted to the US dollar and the average inter-bank exchange rates for the data collection period were used. The changes in the inter-bank rates can cause prices to vary widely. The most current rate at the time of the analysis should always be used when calculating medicine prices. It should be noted that direct comparison of prices between suppliers for a given product may be unrealistic because of the varying units of presentation and terms and services offered by different suppliers. Similarly units of presentation for some of the products in countries are not specified and vary; therefore direct comparison of prices may not be possible and realistic. Taking this into consideration, all attempts will be made to address this gap in the future edition. When calculating and projecting prices, it is important to consider factors such as delivery times, insurance costs, modes of transport (air/sea/land), handling charges. An analysis of these factors is beyond the scope and intent of the present price indicator. However, it is reasonable for estimation purposes to add 20-30% for shipping costs to FOB prices. Tender prices in CIF or DDP prices do not require adjustment for shipping charges. When using the price indicator for comparison with other prices, or for estimating the total value of a proposed procurement list, it is useful to use an average price. The average price is used primarily for budget estimates. The mean price and the median price are the two types of average prices that can be used. The mean price, the most commonly used average, is the simple average of all prices for a medicine: values are added up and divided by the number of values. The mean price is useful when medicine prices are relatively close and the same type prices are used (FOB, EXW etc.) The median price splits a set of values in half when a series is put in ascending order if there is an odd number of a value in the series. When there is an even number of values in the series, the median is calculated by averaging the two middle values. The median value is likely to be more useful in estimating prices (or comparing with local prices) when there is skewed distribution because, unlike the mean value, the median is not affected by outliers i.e. very high or very low values. WHO AFRO – Essential Medicines Price Indicator
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X INCO term X EXW/FOB Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 09-2007 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Not included
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 251
World Health Organization - Malaria Price Information Services
http://www.who.int/medicines/areas/access/med_prices_malaria/en/index.html
Website accessed on 27-04-2010
Source of website
o International: non-profit
� Roll Back Malaria Partnership Secretariat (RBM), WHO, UNICEF, Population
Services International (PSI), and Management Sciences for Health (MSH)
General information
o Country or organization behind the website
� World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� downloadable pdf document
o Languages available
� English, French
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website but date of copyright 2010, however information on prices dated on September 2004; * Site map/search: site map not available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, antimalarial medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Roll Back Malaria Partnership (RBM) and contact information of all organizations working on this project listed in report (RBM Partnership Secretariat, Malaria Medicines and Supplies Service (MMSS), UNICEF Supply Division, WHO Department Essential Drugs and Medicines Policy (EDM)), but not all contact information is still correct (2004 version); * Links: some useful links to other organizations working on essential medicines but no links to
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 252
other price reporting websites; The report provides market information on products reviewed for the prevention, diagnosis and treatment of malaria from 80 manufacturers in 20 countries. It gives purchasers of malaria-related products a range of choices related to suppliers and affordability. This report is the first in a series of annual publications of sources and prices surveys commenced in 2004 by Roll Back Malaria Partnership Secretariat (RBM), WHO, UNICEF, Population Services International (PSI), and Management Sciences for Health (MSH). The report includes sections on antimalarial medicines, mosquito nets, diagnostic tests, insecticides, insecticide spraying equipment, and resistance test kits. The medicines included were selected on the basis of WHO treatment recommendations. The list is not exhaustive but covers the most commonly used antimalarials, with paediatric forms included wherever possible. There is a section on registration status of products. This information will be useful for countries that are in the process of granting market authorization to malaria-related products. Detailed information is provided on the artemisinin-based combination therapy, and on how to place an order for Coartem® through WHO and UNICEF. WHO – Malaria Price Information Services
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Generic medicines only Packaging specifications & size X INCO term X Amount not specified � EXW,
FOB, FCA Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 09-2004 Date of procurement award X Exchange rate at time of award NA NA Prices in US $ Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Not added fright, insurance,
import duties and taxes
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 253
World Health Organization PAHO
http://new.paho.org/hq/index.php?option=com_content&task=view&id=1042&Itemid=988
Website accessed on 30-04-2010
Source of website
o International: non-profit
� Procurement and Supply Management
General information
o Country or organization behind the website
� World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� 4 downloadable pdf documents with product prices: anti Tuberculosis medicines, anti
Malaria medicines, anti Chagas medicines, antiretrovirals (HIV/AIDS)
o Languages available
� English, Spanish (not price documents)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website, price documents last updated April 2009; * Site map/search: site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Strategic Fund and direct contact information available for price documents author; * Links: useful links to related organizations and governmental authorities and news events, but no links to other price reporting websites; One of the objectives of PAHO Strategic Fund is to promote access to affordable medicines in the Americas region. To this end, as far as possible the Strategic Fund will purchase generic drugs if it is clear that its price is lower. In such cases, participating countries must ensure that products
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 254
purchased is consistent with national laws and regulations on patents.
It is recognized that generic drugs represent one of the most efficient cost in the field of public health. In countries like the United States and Canada, although the share of generic drugs in the dollar value of U.S. market as a whole is very small (11% and 15% respectively), almost 50% of prescriptions in both countries are generics. In addition, the WHO report on global drug situation provides important data on the increasing participation of generic drugs on the market in Argentina, Brazil and Mexico. Generic drugs are pharmaceutical products containing the same quantity of the same active ingredients as the original one in which they are based. They begin to be sold after the expiry of the patent or of other exclusive rights, legally obtained from various sources and:
• interchangeable with the original product; • its sale has been approved by national authorities after determining that have the same
quality, safety and efficacy as the original; • are marketed under a non-proprietary name (international nonproprietary name or
another name approved) or a trade name and • can be "branded generics."
According to national legislation, these elements may be different in some countries. For this reason we have introduced the term "proceeds from various sources", which covers both branded generic and unbranded. The basic idea is that, regardless of local variations in the definition, generic drugs are well-known products of proven safety and efficacy WHO PAHO – Procurement and Supply Management
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X Blisters/box INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Updated 04-2009 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 255
Health Action International
http://www.haiweb.org/GlobalDatabase/
Website accessed on 30-04-2010
Source of website
o International: non-profit
� WHO/HAI database of medicine prices, availability, affordability and price
components
General information
o Country or organization behind the website
� Health Action International in collaboration with the World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� searchable internet database
o Languages available
� English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 0
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, price data from time period 2001-2006 depending on survey(last survey December 2006)); * Site map/search: no site map available, search engine provides search on INN name; * Search within prices: search medicines on INN name, query type, strength, dosage form, public sector, private sector, reference data source and survey (author name and publication date listed), but not possible to view entire database (entry in all search fields required); * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on HAI), no contact information listed (not even general contact information); * Links: no useful links, not even a direct link to the main page of HAI, nor links to other price reporting sites; * Important note: very little information given on search results, prices listed in a median price ratio (mpr), 25th percentile price ratio (p25) and 75th percentile price ratio (p75), but not mentioned
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 256
in which currency the prices are calculated; MPR isn’t in a currency as it’s a ratio. It is outlined in the manual how a median price ratio is calculated – see * Query type: - Price and availability per medicine or per survey - One survey - Summary data - Affordability per survey or per condition * Sector: - public sector procurement or patient prices - private pharmacies patient prices - other sector patient prices * Reference datasources used in the surveys: - MSH 2001, 2002, 2003, 2004, 2005 - AustralianPBSNov03 - Spain manufacturer's selling prices 2004 Health Action International - Medicine price surveys (multi country price sources)
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Brand products surveyed’ page Packaging specifications & size X INCO term X Price components page Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2001 to 2006 (depending on
survey) Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 257
Health Action International
http://www.haiweb.org/medicineprices/surveys.php
Website accessed on 30-10-2010
Source of website
o International: non-profit
� HAI medicine prices website
General information
o Country or organization behind the website
� Health Action International
o Basis for access
� free to access, no registration
o Database or other format
� downloadable pfd documents with links to country and multi-country price websites
� hyperlink to HAI Global Database (http://www.haiweb.org/GlobalDatabase/)
o Languages available: English
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information na � Combined score update 2
Site map / Search Site map, useful search engine 0 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information na Download / print version price information x � Combined score accessibility of information 1.5
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update of website in general, but news, publications updated monthly; date of price information is not applicable; * Site map/search: no site map available, no search engine available; * Search within prices: search medicines on INN name, query type, strength, dosage form, public sector, private sector, reference data source and survey (author name and publication date listed), but not possible to view entire database (entry in all search fields required); * Download/print version: download version of document with national and multi-country price sources available, but no direct print version; * Author information: background information on surveys listed and easy to access link to the general HAI website with additional author information; * Links: useful links to other national and international price reporting sites and useful links to publications, presentations and survey manuals for price comparison; * Important note: no price information is available on this website, however on this website several useful links to price databases by HAI and price reporting websites of both national and international sources are available
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 258
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 259
UNICEF
http://www.unicef.org/supply/index_47129.html
Website accessed on 30-04-2010
Source of website
o International: non-profit
� Sources and Prices of Selected Medicines for Children
General information
o Country or organization behind the website
� UNICEF, World Health Organization
o Basis for access
� free to access, no registration
o Database or other format
� downloadable pdf document
o Languages available
� English, Spanish (not price document), French (not price document), Arabic (not price
document), Chinese (not price document)
Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x
No undesired advertisements x � Combined score user-friendliness 2
Update: site & price information
Last update website, site maintenance x Last update price information x � Combined score update 2
Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information
Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1
Speed to search page
Download time at 56 K 2
Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website 27-04-2010, price document last updated 28 April 2010; * Site map/search: no site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines divided into disease categories and within these categories A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information (including methods, results, discussion of survey used to collect medicine prices) on report and contact information of responsible department of WHO and UNICEF listed; * Links: useful links to other websites of the United Nations System of Organizations, but no links to other price reporting websites;
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 260
UNICEF – Sources and prices of selected medicines for children
Procurement price YES NO IF YES (SPECIFICATIONS)
INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 04-2010 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 261
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 262
ANNEX XIV: Amitriptyline 25mg cap/tab Table 33: Prices Amitriptyline 25mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO
Region World Bank Income Category
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0059 NA
Australia WPRO High-income 0.29-0.41#2 AU$ 1.09 05-2010
Austria EURO High-income 0.054#1
0.054 0.081 € 0.74
03-2010 Brazil AMRO Upper-middle-
income 0.0091#1
BRL 1.68
04-2008 Canada AMRO High-income 0.076 CA$ 1.01
04-2010 Czech Republic EURO High-income 0.026#1 0.036 € 0.76
04-2009 Denmark EURO High-income 0.059#1
0.088-0.14 0.088 € 0.76
05-2010 Finland EURO High-income 0.055 0.096 € 0.73
02-2010 France EURO High-income 0.061#1
0.059 #3 0.091 € 0.76
05-2010 Germany EURO High-income 0.27-0.30 € 0.74
04-2010 Hungary EURO Upper-middle-
income 0.041#1 0.041 0.054 € 0.74
03-2010 India Tamil Nadu
SEARO Low-income 0.0024#1
INR 45.4
03-2010 Iran EMRO Lower-middle-
income 0.0087 IRR 9741
2008-2009 Ireland EURO High-income 0.014 € 0.70
01-2010 Italy EURO High-income 0.063 € 0.74
04-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 263
Country WHO Region
World Bank Income Category
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0059 NA
Jordan EMRO Lower-middle-income
0.027 0.034 JOD 0.70 #7 Unknown
Latvia EURO Upper-middle-income
0.014 0.029 € 0.70 01-2010
Lithuania EURO Upper-middle-income
0.015#1
0.015 0.029 € 0.68
02-2008 Morocco EMRO Lower-middle-
income 0.076 0.076 MAD 7.69 #7
Unknown Netherlands EURO High-income 0.049-0.058 0.049 € 0.76
05-2010 New Zealand WPRO High-income 0.025#1 NZ$ 1.38
05-2010 Norway EURO High-income 0.061 0.095 0.095 NOK 6.05
05-2010 Oman EMRO Upper-middle-
income 0.096#6
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.044 € 0.63 07-2008
Portugal EURO High-income 0.016 #4 0.042 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.029#1 0.039 € 0.69 09-2008
Slovenia EURO High-income 0.054 € 0.74 12-2008
South Africa AFRO Upper-middle-income
0.049#1
0.061 ZAR 7.32
04-2010 Spain EURO High-income 0.059#1
0.072 € 0.76
05-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 264
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 39% of Retail/Patient Price
#5 : VAT/GST varies throughout states in USA, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price
#7 : Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Country WHO Region
World Bank Income Category
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0059 NA
Sudan EMRO Low-income 0.018#1
NA
2009 Sweden EURO High-income 0.063 0.090 SEK 7.19
05-2010 Tunisia EMRO Lower-middle-
income 0.025 TND 1.22 #7
Unknown United Kingdom NHS eMIT
EURO High-income 0.0087#1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 0.059 £ 0.66 04/05-2010
United States Veterans Affairs
AMRO High-income 0.017#1
NA
2009-2010 United States MEDICAID
AMRO High-income 0.094#5 NA 2009-2010
United States Kentucky MEDICAID
AMRO High-income 0.044#5 NA 2009-2010
All WHO Regions n = 36
n = 9 n = 6 n = 11 n = 12 n = 21 Median Price 0.041 0.013 0.054 NA 0.054 Mean Price 0.040 0.019 0.042 NA 0.059 Lowest Price 0.015 0.0024 0.014 0.016 0.0087 Highest Price 0.061 0.059 0.063 0.41 0.096 High/Low Ratio 4.1 24.6 4.5 25.6 11.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 265
Table 34: MSH price ratio Amitriptyline 25mg cap/tab per country Country WHO
Region World Bank Income Category
Amitriptyline 25mg - MSH price ratio Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0059 = 1.00
Australia WPRO High-income 49.2-69.5#2 Austria EURO High-income 9.15#1
9.15 13.7
Brazil AMRO Upper-middle-income
1.54#1
Canada AMRO High-income 12.9 Czech Republic EURO High-income 4.41#1 6.10 Denmark EURO High-income 10.0#1 14.9-23.7 14.9 Finland EURO High-income 9.32 16.3 France EURO High-income 10.3#1 10.0#3 15.4 Germany EURO High-income 45.8-50.8 Hungary EURO Upper-middle-
income 6.95#1
6.95 9.15
India SEARO Low-income 0.41#1 Iran EMRO Lower-middle-
income 1.47
Ireland EURO High-income 2.37 Italy EURO High-income 10.7 Jordan EMRO Lower-middle-
income 4.58 5.76
Latvia EURO Upper-middle-income
2.37 4.92
Lithuania EURO Upper-middle-income
2.54#1
2.54 4.92
Morocco EMRO Lower-middle-income
12.9 12.9
Netherlands EURO High-income 8.31-9.83 8.31 New Zealand WPRO High-income 4.24#1 Norway EURO High-income 10.3 16.1 16.1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 266
Country WHO Region
World Bank Income Category
Amitriptyline 25mg - MSH price ratio (0.0059 US$ = 1.00) Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
Oman EMRO Upper-middle-income
16.3#6
Poland EURO Upper-middle-income
7.46
Portugal EURO High-income 2.78#4 7.12 Slovakia EURO Upper-middle-
income 4.92#1
6.61
Slovenia EURO High-income 9.15 South Africa AFRO Upper-middle-
income 8.31#1
10.3
Spain EURO High-income 10.0#1 12.2 Sudan EMRO Low-income 3.05#1 Sweden EURO High-income 10.7 15.3 Tunisia EMRO Lower-middle-
income 4.24
United Kingdom NHS eMIT
EURO High-income 1.47#1
United Kingdom Drug Tariff Scotland/ Tariff England&Wales
EURO High-income 10.0
United States Veterans Affairs
AMRO High-income 2.88#1
United States MEDICAID
AMRO High-income 15.9#5
United States Kentucky MEDICAID
AMRO High-income 7.46#5
All WHO Regions n = 36
n = 9 n = 6 n = 11 n = 12 n = 21 Median Ratio 6.95 2.21 9.15 NA 9.15 Mean Ratio 6.76 3.23 7.07 NA 10.0 Lowest Ratio 2.54 0.41 2.37 2.78 1.47 Highest Ratio 10.3 10.0 10.7 69.5 16.3 High/Low Ratio 4.1 24.6 4.5 25.6 11.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 267
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price
#4 : Reimbursement is 69% of Retail/Patient Price
#5 : VAT/GST varies throughout states in USA, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price
Table 35: AFRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.049#1 8.31#1 0.061 10.3 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 268
Table 36: AMRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.0091
#1 1.54#1
Canada 0.076 12.9 United States Veterans Affairs
0.017#1 2.88#1
United States MEDICAID
0.094#2 15.9#2
United States Kentucky MEDICAID
0.044#2 7.46#2
n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA 0.013 2.21 NA NA NA NA NA NA Mean Price/Ratio NA NA 0.013 2.21 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.0091 1.54 NA NA 0.044 7.461 NA NA Highest Price/Ratio NA NA 0.017 2.88 NA NA 0.094 15.9 NA NA High/Low Ratio NA NA 1.9 1.9 NA NA 2.1 2.1 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 269
Table 37: EMRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 6
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Iran 0.0087 1.47 Jordan 0.027 4.58 0.034 5.76 Morocco 0.076 12.9 0.076 12.9 Oman 0.096#2 16.3#2 Sudan 0.018#1 3.05#1 Tunisia 0.025 4.24 n = 0 n = 1 n = 1 n = 1 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.034 5.76 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.048 8.13 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.0087 1.47 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.096 16.3 High/Low Ratio NA NA NA NA NA NA NA NA 11.0 11.0 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 270
Table 38: EURO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 21
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.054#1 9.15#1 0.054 9.15 0.081 13.7 Czech Republic 0.026#1 4.41#1 0.036 6.10 Denmark 0.059#1 10.0#1 0.088-
0.14 14.9-23.7
0.088 14.9
Finland 0.055 9.32 0.096 16.3 France 0.061#1 10.3#1 0.059#2 10.0#2 0.091 15.4 Germany 0.27-
0.30 45.8-50.8
Hungary 0.041#1 6.95#1 0.041 6.95 0.054 9.15 Ireland 0.014 2.37 Italy 0.063 10.7 Latvia 0.014 2.37 0.029 4.92 Lithuania 0.015#1 2.54#1 0.015 2.54 0.029 4.92 Netherlands 0.049-
0.058 8.31-9.83
0.049 8.31
Norway 0.061 10.3 0.095 16.1 0.095 16.1 Poland 0.044 7.46 Portugal 0.016#3 2.78#3 0.042 7.12 Slovakia 0.029#1 4.92#1 0.039 6.61 Slovenia 0.054 9.15 Spain 0.059#1 10.0#1 0.072 12.2 Sweden 0.063 10.7 0.090 15.3 United Kingdom NHS eMIT
0.0087#1
1.47#1
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
0.059 10.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 271
WHO Region EURO n = 21
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio n = 7 n = 2 n = 9 n = 7 n = 16 Median Price/Ratio 0.041 6.95 NA NA 0.054 9.15 NA NA 0.059 9.92 Mean Price/Ratio 0.041 6.90 0.034 5.74 0.041 6.99 NA NA 0.063 10.6 Lowest Price/Ratio 0.015 2.54 0.0087 1.47 0.014 2.37 0.016 2.78 0.029 4.92 Highest Price/Ratio 0.061 10.3 0.059 10.0 0.063 10.7 0.30 50.8 0.096 16.3 High/Low Ratio 4.1 4.1 6.8 6.8 4.5 4.5 18.8 18.8 3.3 3.3
#1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price #3 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 272
Table 39: SEARO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India 0.0024
#1 0.41#1
n = 0 n = 1 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 273
Table 40: WPRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2
Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.29 -
0.41#2 49.2-69.5#2
New Zealand 0.025#1 4.24#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 274
ANNEX XV: Atenolol 50mg cap/tab Table 41: Prices Atenolol 50mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO
Region World Bank Income Category
Atenolol 50mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.016 NA
Australia WPRO High-income 0.31 - 0.41 #2 AU$ 1.09 05-2010
Austria EURO High-income 0.14 #1
0.16
0.22
€ 0.74 03-2010
Bahrain EMRO High-income 0.27 #7
BHD 0.37 #10 Unknown
Belgium EURO High-income 0.041-0.062 #3 € 0.74 03-2010
Brazil AMRO Upper-middle-income
0.0074 #1
BRL 1.68
04-2008 Canada AMRO High-income 0.26
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.072
€ 0.76 04-2009
Denmark EURO High-income 0.014 #1
0.042-0.13
0.042
€ 0.76 05-2010
Finland EURO High-income 0.082
0.14
€ 0.73 02-2010
France EURO High-income 0.092 #1
0.086-0.093 #4
0.14
€ 0.76 05-2010
Germany EURO High-income 0.24-0.38
€ 0.74 04-2010
Hungary EURO Upper-middle-income
0.027 #1 0.033 0.041
€ 0.74 03-2010
India Tamil Nadu
SEARO Low-income 0.0019 #1
INR 45.4
03-2010 Iran EMRO Lower-middle-
income
0.011 IRR 9741
2008-2009
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 275
Country WHO Region
World Bank Income Category
Atenolol 50mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.016
Ireland EURO High-income 0.20
€ 0.70 01-2010
Italy EURO High-income 0.15
€ 0.74 04-2010
Jordan EMRO Lower-middle-income
0.089
0.12
JOD 0.70 #10 Unknown
Latvia EURO Upper-middle-income
0.043
0.067
€ 0.70 01-2010
Lebanon EMRO Upper-middle-income
0.10 #8
LBP 1489 03-2010
Lithuania EURO Upper-middle-income
0.044 #1
0.049
0.056
€ 0.68 02-2008
Netherlands EURO High-income 0.087-0.090
0.087
€ 0.76 05-2010
New Zealand WPRO High-income 0.0090#1 NZ$ 1.38 05-2010
Norway EURO High-income 0.055
0.069-0.090
0.069
NOK 6.05 05-2010
Oman EMRO Upper-middle-income
0.084 #9
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.030
€ 0.63 07-2008
Portugal EURO High-income 0.049-0.072 #5
0.071
€ 0.74 04-2010
Slovakia EURO Upper-middle-income
0.043 #1 0.058
€ 0.69 09-2008
Slovenia EURO High-income 0.11
€ 0.74 12-2008
South Africa AFRO Upper-middle-income
0.038 #1
0.061
ZAR 7.32
04-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 276
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if included
#7 : VAT/GST unknown, unknown if it is included in price #8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #9 : VAT/GST unknown, unknown if it is included in price
#10: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Country WHO Region
World Bank Income Category
Atenolol 50mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.016
Spain EURO High-income 0.051 #1
0.062
€ 0.76 05-2010
Sudan EMRO Low-income 0.066 #1
NA
2009 Sweden EURO High-income 0.017
0.058
SEK 7.19 05-2010
United Kingdom NHS eMIT
EURO High-income 0.0065 #1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income
0.054 £ 0.66
04/05-2010
United States Veterans Affairs
AMRO High-income 0.0083 #1
NA
2009-2010 United States MEDICAID
AMRO High-income 0.050#6 NA 2009-2010
United States Kentucky MEDICAID
AMRO High-income 0.035 #6 NA 2009-2010
All WHO Regions n = 37
n = 8 n = 6 n = 11 n = 12 n = 21 Median Price 0.044 0.0079 0.058 NA 0.072 Mean Price 0.056 0.017 0.078 NA 0.093 Lowest Price 0.0090 0.0019 0.017 0.035 0.011 Highest Price 0.14 0.066 0.20 0.41 0.27 High/Low Ratio 15.6 34.7 11.8 11.7 24.5
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 277
Table 42: MSH price ratio Atenolol 50mg cap/tab per country Country WHO
Region World Bank Category
Atenolol 50mg - MSH price ratio Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0161 = 1.00
Australia WPRO High-income 19.3-25.5 #2 Austria EURO High-income 8.70 #1 9.94 13.7 Bahrain EMRO High-income 16.8 #7 Belgium EURO High-income 2.55-3.85 #3 Brazil AMRO Upper-middle-
income 0.46 #1
Canada AMRO High-income 16.1 Czech Republic EURO High-income 4.47 Denmark EURO High-income 0.87 #1 2.61-8.07 2.61 Finland EURO High-income 5.09 9.32 France EURO High-income 5.71 #1 5.34-5.78 #4 8.70 Germany EURO High-income 14.9-23.6 Hungary EURO Upper-middle-
income 1.68 #1
2.05 2.55
India Tamil Nadu
SEARO Low-income 0.12 #1
Iran EMRO Lower-middle-income
0.68
Ireland EURO High-income 12.4 Italy EURO High-income 9.38 Jordan EMRO Lower-middle-
income 5.53 7.45
Latvia EURO Upper-middle-income
2.67 4.16
Lebanon EMRO Upper-middle-income
6.21
Lithuania EURO Upper-middle-income
2.73 #1
3.04 3.48
Netherlands EURO High-income 5.40-5.59 5.40
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 278
Country WHO Region
World Bank Category
Atenolol 50mg - MSH price ratio (0.0161 US$ = 1.00) Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
New Zealand WPRO High-income 0.56#1 Norway EURO High-income 3.42 4.29-5.59 4.29 Oman EMRO Upper-middle-
income 5.22 #8
Poland EURO Upper-middle-income
1.86
Portugal EURO High-income 3.04-4.47#5 4.41 Slovakia EURO Upper-middle-
income 2.67 #1 3.60
Slovenia EURO High-income 6.83 South Africa AFRO Upper-middle-
income 2.36 #1 3.79
Spain EURO High-income 3.17 #1 3.85 Sudan EMRO Low-income 4.10 #1 Sweden EURO High-income 1.06 3.60 United Kingdom NHS eMIT
EURO High-income 0.40 #1
United Kingdom Drug Tariff Scotland/ Tariff England&Wales
EURO High-income 3.35
United States Veterans Affairs
AMRO High-income 0.52 #1
United States MEDICAID
AMRO High-income 3.11 #6
United States Kentucky MEDICAID
AMRO High-income 2.17 #6
All WHO Regions n = 37
n = 8 n = 6 n = 11 n = 12 n = 21 Median Ratio 2.70 0.49 3.60 NA 4.41 Mean Ratio 3.45 1.08 4.84 NA 5.77 Lowest Ratio 0.56 0.12 1.06 2.17 0.68 Highest Ratio 8.70 4.10 12.4 25.5 16.8 High/Low Ratio 15.6 34.7 11.8 11.7 24.5
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 279
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price
#5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if it is included in price #7 : VAT/GST unknown, unknown if it is included in price
#8 : VAT/GST unknown, unknown if it is included in price
Table 43: AFRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.038 2.36 0.061 3.79 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 280
Table 44: AMRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.0074
#1 0.46#1
Canada 0.26 16.1 United States Veterans Affairs
0.0083#1
0.52#1
United States MEDICAID
0.050#2 3.11#2
United States Kentucky MEDICAID
0.035#2 2.17#2
n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.0079 0.49 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.0074 0.46 NA NA 0.035 2.17 NA NA Highest Price/Ratio NA NA 0.0083 0.52 NA NA 0.26 16.1 NA NA High/Low Ratio NA NA 1.1 1.1 NA NA 7.4 7.4 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 281
Table 45: EMRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 6
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.27#2 16.8#2 Iran 0.011 0.68 Jordan 0.089 5.53 0.12 7.45 Lebanon 0.10 6.21 Oman 0.084#2 5.22#2 Sudan 0.066#1 4.10#1 n = 0 n = 1 n = 1 n = 0 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.10 6.21 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.12 7.27 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.011 0.68 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.27 16.8 High/Low Ratio NA NA NA NA NA NA NA NA 24.5 24.5 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 282
Table 46: EURO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.14#1 8.70#1 0.16 9.94 0.22 13.7 Belgium 0.041-
0.062#2 2.55-3.85#2
Czech Republic 0.072 4.47 Denmark 0.014#1 0.87#1 0.042-
0.13 2.61-8.07
0.056 2.61
Finland 0.082 5.09 0.15 9.32 France 0.092#1 5.71#1 0.086-
0.093#3 5.34-5.78#3
0.14 8.70
Germany 0.24-0.38
14.9-23.6
Hungary 0.027#1 1.68#1 0.033 2.05 0.041 2.55 Ireland 0.20 12.4 Italy 0.15 9.32 Latvia 0.043 2.67 0.067 4.16 Lithuania 0.044#1 2.73#1 0.049 3.04 0.056 3.48 Netherlands 0.087-
0.090 5.40-5.59
0.087 5.40
Norway 0.055 3.42 0.069-0.090
4.29-5.59
0.069 4.29
Poland 0.030 1.86 Portugal 0.049-
0.072#4 3.04-4.47#4
0.071 4.41
Slovakia 0.043#1 2.67#1 0.058 3.60 Slovenia 0.11 6.83 Spain 0.051#1 3.17#1 0.062 3.85 Sweden 0.017 1.06 0.058 3.60 United Kingdom NHS eMIT
0.0065#1
0.40#1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 283
United Kingdom Drug Tariff Scotland/ Tariff England&Wales
0.054 3.35
Ex-factory /
Manufacturer Procurement Wholesale Reimbursement Retail / Patient
n = 6 n = 2 n = 9 n = 8 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Median Price/Ratio 0.048 2.95 NA NA 0.055 3.42 NA NA 0.068 4.22 Mean Price/Ratio 0.066 4.11 0.010 0.64 0.083 5.16 NA NA 0.087 5.40 Lowest Price/Ratio 0.027 1.68 0.0065 0.40 0.017 1.06 0.041 2.55 0.030 1.86 Highest Price/Ratio 0.14 8.70 0.014 0.87 0.20 12.4 0.38 23.6 0.22 13.7 High/Low Ratio 5.2 5.2 2.2 2.2 11.8 11.8 9.3 9.3 7.3 7.3
#1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price
#3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 284
Table 47: SEARO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India Tamil Nadu
0.0019#1
0.12#1
n = 0 n = 1 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 285
Table 48: WPRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2
Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.31 -
0.41#2 19.3-25.5#2
New Zealand 0.0090#1 0.56#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 286
ANNEX XVI: Ciprofloxacin 500mg cap/tab Table 49: Prices Ciprofloxacin 500mg cap/tab per country (prices in US$ per cap/tab, excl taxes)
Country WHO Region
World Bank Category
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0372 NA
Australia
WPRO High-income 1.02#2
AU$ 1.09
05-2010 Austria EURO High-income 1.14#1
1.27 1.71 € 0.74
03-2010 Bahrain EMRO High-income 0.98 #7 BHD 0.37 #10
unknown Belgium EURO High-income 0.44-0.48 #3 € 0.74
03-2010 Brazil AMRO Upper-middle-
income 0.052 #1
BRL 1.68
04-2008 Canada AMRO High-income 1.14
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.32 € 0.76
04-2009 Denmark EURO High-income 0.24 #1
0.32 € 0.76
05-2010 Finland EURO High-income 0.096 0.19 € 0.73
02-2010 France EURO High-income 1.06#1
1.04 #4 1.60 € 0.76
05-2010 Germany EURO High-income 1.20-1.65 € 0.74
04-2010 Hungary EURO Upper-middle-
income 0.35#1 0.38 0.47 € 0.74
03-2010 India Tamil Nadu
SEARO Low-income 0.019#1 INR 45.4 03-2010
India NPPA
SEARO Low-income 0.13 INR 45.4
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 287
03-2010 Country WHO
Region World Bank Category
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0372 NA
Iran EMRO Lower-middle-income
0.087
IRR 9741 2008-2009
Ireland EURO High-income 1.47 € 0.70 01-2010
Italy EURO High-income 1.51 € 0.74 04-2010
Jordan EMRO Lower-middle-income
0.39 0.50 JOD 0.70 #10 unknown
Latvia EURO Upper-middle-income
0.49 0.61 € 0.70 01-2010
Lebanon EMRO Upper-middle-income
0.45 #8
LBP 1489 03-2010
Lithuania EURO Upper-middle-income
0.46#1
0.50 0.59 € 0.68
02-2008 Morocco EMRO Lower-middle-
income 0.94-1.02 0.94 MAD 7.69 #10
unknown Netherlands EURO High-income 0.14-0.15 0.14 € 0.76
05-2010 New Zealand WPRO High-income 0.10#1 NZ$ 1.38
05-2010 Norway EURO High-income 1.22
0.83-0.89 1.24 NOK 6.05
05-2010 Oman EMRO Upper-middle-
income 0.46#9
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.38 € 0.63 07-2008
Portugal EURO High-income 0.68 #5 0.99 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.42#1 0.61 € 0.69 09-2008
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 288
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
#3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price
Country WHO Region
World Bank Category
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0372 NA
Slovenia EURO High-income 1.04 € 0.74 12-2008
South Africa AFRO Upper-middle-income
0.19#1
0.24 ZAR 7.32
04-2010 Spain EURO High-income 0.17#1
0.27 € 0.76
05-2010 Sudan EMRO Low-income 0.15#1
NA
2009 Sweden EURO High-income 0.083 0.29 SEK 7.19
05-2010 Tunisia EMRO Lower-middle-
income 0.53 TND 1.22 #11
unknown United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 0.11 £ 0.66 04/05-2010
United Kingdom NHS eMIT
EURO High-income 0.044#1
£ 0.66
04/05-2010 United States Veterans Affairs
AMRO High-income 0.058#1
NA
2009-2010 United States MEDICAID
AMRO High-income 0.45#6 NA 2009-2010
All WHO Regions n = 39
n = 8 n = 6 n = 11 n = 11 n = 24 Median Price 0.39 0.055 0.49 NA 0.49
Mean Price 0.49 0.094 0.65 NA 0.64 Lowest Price 0.10 0.019 0.083 0.11 0.087 Highest Price 1.14 0.24 1.47 1.65 1.71 High/Low Ratio 11.4 12.6 17.7 15.0 19.7
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 289
#5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if it is included in price #7 : VAT/GST unknown, unknown if it is included in price
#8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price
#9 : VAT/GST unknown, unknown if it is included in price
#10: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 290
Table 50: MSH price ratio Ciprofloxacin 500mg cap/tab per country Country pppWH
O Region
World Bank Category
Ciprofloxacin 500mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0372 = 1.00
Australia
WPRO High-income 27.4#2
Austria EURO High-income 30.6#1
34.1 45.9
Bahrain EMRO High-income 26.3#7 Belgium EURO High-income 11.8-12.9#3 Brazil AMRO Upper-middle-
income 1.40#1
Canada AMRO High-income 30.6
Czech Republic EURO High-income 8.60 Denmark EURO High-income 6.45 #1
8.60
Finland EURO High-income 2.58 5.11 France EURO High-income 28.5#1
28.0 #4 43.0
Germany EURO High-income 32.3-44.4 Hungary EURO Upper-middle-
income 9.41#1 10.2 12.6
India Tamil Nadu
SEARO Low-income 0.51#1
India NPPA
SEARO Low-income 3.49
Iran EMRO Lower-middle-income
2.34
Ireland EURO High-income 39.5 Italy EURO High-income 40.6 Jordan EMRO Lower-middle-
income 10.5 13.4
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 291
Country WHO Region
World Bank Category
Ciprofloxacin 500mg (0.0372 US$ = 1.00) Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
Latvia EURO Upper-middle-income
13.2 16.4
Lebanon EMRO Upper-middle-income
12.1#8
Lithuania EURO Upper-middle-income
12.4#1
13.4 15.9
Morocco EMRO Lower-middle-income
25.3-27.4 25.3
Netherlands EURO High-income 3.76-4.03 3.76 New Zealand WPRO High-income 2.69#1 Norway EURO High-income 32.8
22.3-23.9 33.3
Oman EMRO Upper-middle-income
12.4#9
Poland EURO Upper-middle-income
10.2
Portugal EURO High-income 18.3#5 26.6 Slovakia EURO Upper-middle-
income 11.3#1 16.4
Slovenia EURO High-income 27.9 South Africa AFRO Upper-middle-
income 5.11#1
6.45
Spain EURO High-income 4.57#1
7.26
Sudan EMRO Low-income 4.03#1
Sweden EURO High-income 2.23 7.80 Tunisia EMRO Lower-middle-
income 14.2
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 2.96
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 292
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if it is included in price
#7 : VAT/GST unknown, unknown if it is included in price
#8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #9 : VAT/GST unknown, unknown if it is included in price
#10: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Country WHO Region
World Bank Category
Ciprofloxacin 500mg (0.0372 US$ = 1.00) Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
United Kingdom NHS eMIT
EURO High-income 1.18#1
United States Veterans Affairs
AMRO High-income 1.56#1
United States MEDICAID
AMRO High-income 12.1#6
All WHO Regions n = 39
n = 8 n = 6 n = 11 n = 11 n = 24 Median Ratio 10.3 1.48 13.2 NA 13.0 Mean Ratio 13.1 2.52 17.5 NA 17.2 Lowest Ratio 2.69 0.511 2.23 2.96 2.34 Highest Ratio 30.6 6.45 39.5 44.4 45.9 High/Low Ratio 11.4 12.6 17.7 15.0 19.7
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 293
Table 51: AFRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.19#1 5.11#1 0.24 6.45 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 294
Table 52: AMRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 4
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.052#1 1.40#1 Canada 1.14 30.6 United States Veterans Affairs
0.058#1 1.56#1
United States MEDICAID
0.45#2 12.1#2
n = 0 n = 2 n = 0 n = 2 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.055 1.48 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.052 1.40 NA NA 0.45 12.1 NA NA Highest Price/Ratio NA NA 0.058 1.56 NA NA 1.14 30.6 NA NA High/Low Ratio NA NA 1.12 1.12 NA NA 2.53 2.53 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 295
Table 53: EMRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 8
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.98#2 26.3#2 Iran 0.087 2.34
Jordan 0.39 10.5 0.50 13.4 Lebanon 0.45#3 12.1#3 Morocco 0.94-
1.02 25.3-27.4
0.94 25.3
Oman 0.46#2 12.4#2 Sudan 0.15#1 4.03#1 Tunisia 0.53 14.2 n = 0 n = 1 n = 1 n = 1 n = 7 Median Price/Ratio NA NA NA NA NA NA NA NA 0.50 13.4 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.56 15.2 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.087 2.34 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.98 26.3 High/Low Ratio NA NA NA NA NA NA NA NA 11.3 11.3 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
#3: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 296
Table 54: EURO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 1.14#1 30.6#1 1.27 34.1 1.71 45.9 Belgium 0.44-
0.48#2 11.8-12.9#2
Czech Republic 0.32 8.60 Denmark 0.24#1 6.45 #1 0.32 8.60 Finland 0.096 2.58 0.19 5.11 France 1.06#1 28.5#1 1.04#3 28.0#3 1.60 43.0 Germany 1.20-
1.65 32.3-44.4
Hungary 0.35#1 9.41#1 0.38 10.2 0.47 12.6 Ireland 1.47 39.5 Italy 1.51 40.6 Latvia 0.49 13.2 0.61 16.4 Lithuania 0.46#1 12.4#1 0.50 13.4 0.59 15.9 Netherlands 0.14-
0.15 3.76-4.03
0.14 3.76
Norway 1.22 32.8 0.83-0.89
22.3-23.9
1.24 33.3
Poland 0.38 10.2 Portugal 0.68#4 18.3#4 0.99 26.6 Slovakia 0.42#1 11.3#1 0.61 16.4 Slovenia 1.04 27.9 Spain 0.17#1 4.57#1 0.27 7.26 Sweden 0.083 2.23 0.29 7.80 United Kingdom NHS eMIT
0.044#1 1.18#1
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
0.11 2.96
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 297
Ex-factory /
Manufacturer Procurement Wholesale Reimbursement Retail / Patient
n = 6 n = 2 n = 9 n = 7 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Median Price/Ratio 0.44 11.8 NA NA 0.50 13.4 NA NA 0.53 14.2 Mean Price/Ratio 0.60 16.1 0.14 3.82 0.73 19.6 NA NA 0.71 18.9 Lowest Price/Ratio 0.17 4.57 0.044 1.18 0.083 2.23 0.11 2.96 0.14 3.76 Highest Price/Ratio 1.14 30.6 0.24 6.45 1.47 39.5 1.65 44.4 1.71 45.9 High/Low Ratio 6.71 6.71 5.45 5.45 17.7 17.7 15.0 15.0 12.2 12.2 #1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 298
Table 55: SEARO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 2
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India Tamil Nadu
0.019#1 0.51#1
India NPPA
0.13 3.49
n = 0 n = 1 n = 0 n = 0 n = 1 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 299
Table 56: WPRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2
Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 1.02#2 27.4#2 New Zealand 0.10#1 2.69#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 300
ANNEX XVII: Glibenclamide 5mg cap/tab Table 57: Prices Glibenclamide 5mg cap/tab per country (prices in US$ per cap/tab, excl taxes)
Country WHO Region
World Bank Category
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0045 NA
Australia
WPRO High-income 0.12-0.15#2
AU$ 1.09
05-2010 Austria EURO High-income 0.094#1
0.11 0.16 € 0.74
03-2010 Bahrain EMRO High-income 0.23 #6 BHD 0.37 #8
unknown Brazil AMRO Upper-middle-
income 0.0078#1
BRL 1.68
04-2008 Canada AMRO High-income 0.062
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.013#1 0.013 € 0.76
04-2009 France EURO High-income 0.061#1
0.057#3 0.087 € 0.76
05-2010 Germany EURO High-income 0.20-0.22 € 0.74
04-2010 India Tamil Nadu
SEARO Low-income 0.00073#1 INR 45.4 03-2010
Iran EMRO Lower-middle-income
0.010
IRR 9741 2008-2009
Ireland EURO High-income 0.10 € 0.70 01-2010
Italy EURO High-income 0.12 € 0.74 04-2010
Jordan EMRO Lower-middle-income
0.036 0.046 JOD 0.70 #8 unknown
Lithuania EURO Upper-middle-income
0.014#1
0.015 0.015 € 0.68
02-2008
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 301
Country WHO Region
World Bank Category
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0045 NA
Morocco EMRO Lower-middle-income
0.061-0.10 0.061 MAD 7.69 #8 unknown
Netherlands EURO High-income 0.080-0.082 0.080 € 0.76 05-2010
Oman EMRO Upper-middle-income
0.052#7
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.015 € 0.63 07-2008
Portugal EURO High-income 0.064 #4 0.067 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.014#1 0.015 € 0.69 09-2008
Slovenia EURO High-income 0.080#1 0.081 0.15 € 0.74 12-2008
South Africa AFRO Upper-middle-income
0.021#1
0.028 ZAR 7.32
04-2010 Spain EURO High-income 0.020#1
0.031 € 0.76
05-2010 Sudan EMRO Low-income 0.022#1
NA
2009 Tunisia EMRO Lower-middle-
income 0.033 TND 1.22 #8
unknown United Kingdom NHS eMIT
EURO High-income 0.0087#1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland / Drug Tariff England&Wales
EURO High-income 0.055 £ 0.66 04/05-2010
United States Veterans Affairs
AMRO High-income 0.018#1
NA
2009-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 302
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 95% of Retail/Patient Price
#5 : VAT/GST varies throughout states in USA, unknown if it is included in price
#6 : VAT/GST unknown, unknown if it is included in price
#7: VAT/GST unknown, unknown if it is included in price
#8: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Country WHO Region
World Bank Category
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0045 NA
United States MEDICAID
AMRO High-income 0.28#5 NA 2009-2010
United States Kentucky MEDICAID
AMRO High-income 0.19#5 NA 2009-2010
All WHO Regions n = 30
n = 8 n = 5 n = 6 n = 10 n = 17 Median Price 0.021 0.0087 0.059 NA 0.052
Mean Price 0.040 0.011 0.062 NA 0.070 Lowest Price 0.013 0.00073 0.015 0.055 0.010 Highest Price 0.094 0.022 0.11 0.28 0.23 High/Low Ratio 7.2 30.1 7.3 5.1 23.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 303
Table 58: MSH price ratio Glibenclamide 5mg cap/tab per country Country WHO
Region World Bank Category
Glibenclamide 5mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0045 = 1.00
Australia
WPRO High-income 26.7-33.3#2
Austria EURO High-income 20.9#1
24.4 35.6
Bahrain EMRO High-income 51.1#6 Brazil AMRO Upper-middle-
income 1.73#1
Canada AMRO High-income 13.8
Czech Republic EURO High-income 2.89#1 2.89 France EURO High-income 13.6#1
12.7#3 19.3
Germany EURO High-income 44.4-48.9 India Tamil Nadu
SEARO Low-income 0.16#1
Iran EMRO Lower-middle-income
2.22
Ireland EURO High-income 22.2 Italy EURO High-income 26.7 Jordan EMRO Lower-middle-
income 8.00 10.2
Lithuania EURO Upper-middle-income
3.11#1
3.33 3.33
Morocco EMRO Lower-middle-income
13.6-22.2 13.6
Netherlands EURO High-income 17.8-18.2 17.8 Oman EMRO Upper-middle-
income 11.6#7
Poland EURO Upper-middle-
income 3.33
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 304
Country WHO Region
World Bank Category
Glibenclamide 5mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0045 = 1.00
Portugal EURO High-income 14.2#4 14.9 Slovakia EURO Upper-middle-
income 3.11#1 3.33
Slovenia EURO High-income 17.8#1 18.0 33.3 South Africa AFRO Upper-middle-
income 4.67#1
6.22
Spain EURO High-income 4.44#1
6.89
Sudan EMRO Low-income 4.89#1
Tunisia EMRO Lower-middle-income
7.33
United Kingdom NHS eMIT
EURO High-income 1.93#1
United Kingdom Drug Tariff Scotland / Drug Tariff England&Wales
EURO High-income 12.2
United States Veterans Affairs
AMRO High-income 4.00#1
United States MEDICAID
AMRO High-income 62.2#5
United States Kentucky MEDICAID
AMRO High-income 42.2#5
All WHO Regions n = 30
n = 8 n = 5 n = 6 n = 10 n = 17 Median Ratio 4.56 1.93 13.0 NA 11.6 Mean Ratio 8.81 2.54 13.7 NA 15.5 Lowest Ratio 2.89 0.162 3.33 12.2 2.22 Highest Ratio 20.9 4.89 24.4 62.2 51.1 High/Low Ratio 7.2 30.1 7.3 5.1 23.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 305
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 95% of Retail/Patient Price
#5 : VAT/GST varies throughout states in USA, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price
#7: VAT/GST unknown, unknown if it is included in price
Table 59: AFRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.021#1 4.67#1 0.028 6.22 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 306
Table 60: AMRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.0078
#1 1.73#1
Canada 0.062 13.8 United States Veterans Affairs
0.018#1 4.00#1
United States MEDICAID
0.28#2 62.2#2
United States Kentucky MEDICAID
0.19#2 42.2#2
n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.013 2.87 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.0078 1.73 NA NA 0.062 13.8 NA NA Highest Price/Ratio NA NA 0.018 4.00 NA NA 0.28 62.2 NA NA High/Low Ratio NA NA 2.3 2.3 NA NA 4.5 4.5 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 307
Table 61: EMRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.23#2 51.1#2 Iran 0.010 2.22
Jordan 0.036 8.00 0.046 10.2 Morocco 0.061-
0.10 13.6-22.2
0.061 13.6
Oman 0.052#2 11.6#2 Sudan 0.022#1 4.89#1 Tunisia 0.033 7.33 n = 0 n = 1 n = 1 n = 1 n = 6 Median Price/Ratio NA NA NA NA NA NA NA NA 0.049 10.9 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.072 16.0 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.010 2.22 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.23 51.1 High/Low Ratio NA NA NA NA NA NA NA NA 23.0 23.0 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 308
Table 62: EURO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 15
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.094#1 20.9#1 0.11 24.4 0.16 35.6 Czech Republic 0.013#1 2.89#1 0.013 2.89 France 0.061#1 13.6#1 0.057#2 12.7#2 0.087 19.3 Germany 0.20-
0.22 44.4-48.9
Ireland 0.10 22.2 Italy 0.12 26.7 Lithuania 0.014#1 3.11#1 0.015 3.33 0.015 3.33 Netherlands 0.080-
0.082 17.8-18.2
0.080 17.8
Poland 0.015 3.33 Portugal 0.064#3 14.2#3 0.067 14.9 Slovakia 0.014#1 3.11#1 0.015 3.33 Slovenia 0.080#1 17.8#1 0.081 18.0 0.15 33.3 Spain 0.020#1 4.44#1 0.031 6.89 United Kingdom NHS eMIT
0.0087#1
1.93#1
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
0.055 12.2
n = 7 n = 1 n = 4 n = 5 n = 11 Median Price/Ratio 0.020 4.44 NA NA 0.091 20.1 NA NA 0.067 14.9 Mean Price/Ratio 0.042 9.40 NA NA 0.077 17.0 NA NA 0.069 15.3 Lowest Price/Ratio 0.013 2.89 NA NA 0.015 3.33 0.055 12.2 0.013 2.89 Highest Price/Ratio 0.094 20.9 NA NA 0.11 24.4 0.22 48.9 0.16 35.6 High/Low Ratio 7.2 7.2 NA NA 7.3 7.3 4.0 4.0 12.3 12.3 #1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price
#3 : Reimbursement is 95% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 309
Table 63: SEARO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India Tamil Nadu
0.00073#1
0.16#1
n = 0 n = 1 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 310
Table 64: WPRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 1
Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.12-
0.15#1 26.7-33.3#1
n = 0 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 311
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 312
ANNEX XVIII: Omeprazole 20mg cap/tab Table 65: Prices Omeprazole 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes)
Country WHO Region
World Bank Category
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 NA
Australia
WPRO High-income 0.93-1.02#2
AU$ 1.09
05-2010 Austria EURO High-income 0.36#1
0.41 0.55 € 0.74
03-2010 Bahrain EMRO High-income 0.69#7 BHD 0.37 #8
unknown Belgium EURO High-income 0.13-0.19#3 € 0.74
03-2010 Brazil AMRO Upper-middle-
income 0.027#1
BRL 1.68
04-2008 Canada AMRO High-income 1.01
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.24 € 0.76
04-2009 Denmark EURO High-income 0.047#1
0.076-0.16 0.076 € 0.76
05-2010 Finland EURO High-income 0.15 0.26 € 0.73
02-2010 France EURO High-income 0.41#1
0.49#4 0.74 € 0.76
05-2010 Germany EURO High-income 0.39-1.09 € 0.74
04-2010 Hungary EURO Upper-middle-
income 0.47#1 0.50 0.61 € 0.74
03-2010 India Tamil Nadu
SEARO Low-income 0.0050#1 INR 45.4 03-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 313
Country WHO Region
World Bank Category
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 NA
Iran EMRO Lower-middle-income
0.069 IRR 9741 2008-2009
Ireland EURO High-income 1.07 € 0.70 01-2010
Italy EURO High-income 0.65 € 0.74 04-2010
Jordan EMRO Lower-middle-income
0.54 0.68 JOD 0.70 #8 unknown
Latvia EURO Upper-middle-income
0.28 0.36 € 0.70 01-2010
Lithuania EURO Upper-middle-income
0.21#1
0.22 0.26 € 0.68
02-2008 Morocco EMRO Lower-middle-
income 0.31-1.66 0.31 MAD 7.69 #8
unknown Netherlands EURO High-income 0.033-0.087 0.033 € 0.76
05-2010 New Zealand WPRO High-income 0.061#1 NZ$ 1.38
05-2010 Norway EURO High-income 0.20
0.24-0.63 0.24 NOK 6.05
05-2010 Oman EMRO Upper-middle-
income 0.39#7
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.40 € 0.63 07-2008
Portugal EURO High-income 0.41#5 0.59 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.11#1 0.17 € 0.69 09-2008
Slovenia EURO
High-income 0.54 € 0.74 12-2008
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 314
Country WHO
Region World Bank Category
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 NA
South Africa AFRO Upper-middle-income
0.45#1
0.61 ZAR 7.32
04-2010 Spain EURO High-income 0.089#1
0.14 € 0.76
05-2010 Sudan EMRO Low-income 0.16#1
NA
2009 Sweden EURO High-income 0.035 0.076 SEK 7.19
05-2010 Tunisia EMRO Lower-middle-
income 0.58 TND 1.22 #8
unknown United Kingdom NHS eMIT
EURO High-income 0.040#1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 0.11 £ 0.66 04/05-2010
United States Veterans Affairs
AMRO High-income 0.14#1
NA
2009-2010 United States Kentucky MEDICAID
AMRO High-income 0.27#6 NA 2009-2010
All WHO Regions n = 37
n = 8 n = 6 n = 11 n = 12 n = 22 Median Price 0.29 0.044 0.41 NA 0.34
Mean Price 0.27 0.070 0.41 NA 0.37 Lowest Price 0.061 0.0050 0.035 0.033 0.033 Highest Price 0.47 0.16 1.07 1.66 0.74 High/Low Ratio 7.7 32.0 30.6 50.3 22.4
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 315
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price
#6: VAT/GST varies throughout states in USA, unknown if it is included in price #7 : VAT/GST unknown, unknown if it is included in price #8: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 316
Table 66: MSH price ratio Omeprazole 20mg cap/tab per country Country WHO
Region World Bank Category
Omeprazole 20mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 = 1.00
Australia
WPRO High-income 28.4-31.1#2
Austria EURO High-income 11.0#1
12.5 16.8
Bahrain EMRO High-income 21.0#7 Belgium EURO High-income 3.96-5.79#3 Brazil AMRO Upper-middle-
income 0.82#1
Canada AMRO High-income 30.8
Czech Republic EURO High-income 7.32 Denmark EURO High-income 1.43#1
2.32-4.88 2.32
Finland EURO High-income 4.57 7.93 France EURO High-income 12.5#1
14.9#4 22.6
Germany EURO High-income 11.9-33.2 Hungary EURO Upper-middle-
income 14.3#1 15.2 18.6
India Tamil Nadu
SEARO Low-income 0.15#1
Iran EMRO Lower-middle-income
2.10
Ireland EURO High-income 32.6 Italy EURO High-income 19.8 Jordan EMRO Lower-middle-
income 16.5 20.7
Latvia EURO Upper-middle-income
8.54 11.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 317
Country WHO Region
World Bank Category
Omeprazole 20mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 = 1.00
Lithuania EURO Upper-middle-income
6.40#1
6.71 7.93
Morocco EMRO Lower-middle-income
9.45-50.6 9.45
Netherlands EURO High-income 1.01-2.65 1.01 New Zealand WPRO High-income 1.86#1 Norway EURO High-income 6.10
7.32-19.2 7.32
Oman EMRO Upper-middle-income
11.9#8
Poland EURO Upper-middle-income
12.2
Portugal EURO High-income 12.5#5 18.0 Slovakia EURO Upper-middle-
income 3.35#1 5.18
Slovenia EURO High-income 16.5 South Africa AFRO Upper-middle-
income 13.7#1
18.6
Spain EURO High-income 2.71#1
4.27
Sudan EMRO Low-income 4.88#1
Sweden EURO High-income 1.07 2.32 Tunisia EMRO Lower-middle-
income 17.7
United Kingdom NHS eMIT
EURO High-income 1.22#1
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 3.35
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 318
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price
#5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if it is included in price #7 : VAT/GST unknown, unknown if it is included in price
#8 : VAT/GST unknown, unknown if it is included in price
Country WHO Region
World Bank Category
Omeprazole 20mg Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0328 = 1.00
United States Veterans Affairs
AMRO High-income 4.27#1
United States Kentucky MEDICAID
AMRO High-income 8.23#6
All WHO Regions n = 37
n = 8 n = 6 n = 11 n = 12 n = 22 Median Ratio 8.69 1.33 12.5 NA 10.2 Mean Ratio 8.23 2.13 12.6 NA 11.3 Lowest Ratio 1.86 0.152 1.07 1.01 1.01 Highest Ratio 14.3 4.88 32.6 50.6 22.6 High/Low Ratio 7.7 32.0 30.6 50.3 22.4
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 319
Table 67: AFRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.45#1 13.7#1 0.61 18.6 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 320
Table 68: AMRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 4
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.027#1 0.82#1 Canada 1.01 30.8 United States Veterans Affairs
0.14#1 4.27#1
United States Kentucky MEDICAID
0.27#2 8.23#2
n = 0 n = 2 n = 0 n = 2 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.084 2.55 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.027 0.82 NA NA 0.27 8.23 NA NA Highest Price/Ratio NA NA 0.14 4.27 NA NA 1.01 30.8 NA NA High/Low Ratio NA NA 5.2 5.2 NA NA 3.7 3.7 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 321
Table 69: EMRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.69#2 21.0#2 Iran 0.069 2.10
Jordan 0.54 16.5 0.68 20.7 Morocco 0.31-
1.66 9.45-50.6
0.31 9.45
Oman 0.39#2 11.9#2 Sudan 0.16#1 4.88#1 Tunisia 0.58 17.7 n = 0 n = 1 n = 1 n = 1 n = 6 Median Price/Ratio NA NA NA NA NA NA NA NA 0.49 14.8 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.45 13.8 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.069 2.10 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.69 21.0 High/Low Ratio NA NA NA NA NA NA NA NA 10.0 10.0 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 322
Table 70: EURO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.36#1 11.0#1 0.41 12.5 0.55 16.8 Belgium 0.13-
0.19#2 3.96-5.79#2
Czech Republic 0.24 7.32 Denmark 0.047#1 1.43 #1 0.076-
0.16 2.32-4.88
0.076 2.32
Finland 0.15 4.57 0.26 7.93 France 0.41#1 12.5#1 0.49#3 14.9#3 0.74 22.6 Germany 0.39-
1.09 11.9-33.2
Hungary 0.47#1 14.3#1 0.50 15.2 0.61 18.6 Ireland 1.07 32.6 Italy 0.65 19.8 Latvia 0.28 8.54 0.36 11.0 Lithuania 0.21#1 6.40#1 0.22 6.71 0.26 7.93 Netherlands 0.033-
0.087 1.01-2.65
0.033 1.01
Norway 0.20 6.10
0.24-0.63
7.32-19.2
0.24 7.32
Poland 0.40 12.2 Portugal 0.41#4 12.5#4 0.59 18.0 Slovakia 0.11#1 3.35#1 0.17 5.18 Slovenia 0.54 16.5 Spain 0.089#1 2.71#1 0.14 4.27 Sweden 0.035 1.07 0.076 2.32 United Kingdom NHS eMIT
0.040#1 1.22#1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 323
WHO Region EURO n = 22
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Price Ratio Price Ratio Price United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
0.11 3.35
n = 6 n = 2 n = 9 n = 8 n = 16 Median Price/Ratio 0.29 8.69 NA NA 0.28 8.54 NA NA 0.26 7.93 Mean Price/Ratio 0.27 8.38 0.044 1.33 0.38 11.5 NA NA 0.34 10.4 Lowest Price/Ratio 0.089 2.71 0.040 1.22 0.035 1.07 0.033 1.01 0.033 1.01 Highest Price/Ratio 0.47 14.3 0.047 1.43 1.07 32.6 1.09 33.2 0.74 22.6 High/Low Ratio 5.3 5.3 1.2 1.2 30.6 30.6 33.0 33.0 22.4 22.4 #1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 324
Table 71: SEARO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India Tamil Nadu
0.0050#1
0.15#1
n = 0 n = 1 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 325
Table 72: WPRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2
Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.93-
1.02#2 28.4-31.1#2
New Zealand 0.061#1 1.86#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 326
ANNEX XIX: Salbutamol inhaler 100mcg/dose Table 73: Prices Salbutamol inhaler 100mcg/dose dose per country (prices in US$ per dose, excl taxes)
Country WHO Region
World Bank Category
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0090 NA
Australia
WPRO High-income 0.075-0.092#2
AU$ 1.09
05-2010 Austria EURO High-income 0.013#1
0.014 0.027 € 0.74
03-2010 Bahrain EMRO High-income 0.024#5 BHD 0.37 #7
unknown Brazil AMRO Upper-middle-
income 0.013 #1
BRL 1.68
04-2008 Canada AMRO High-income 0.029
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.013 #1
€ 0.76
04-2009 Denmark EURO High-income 0.065 #1
0.080-0.090 0.080 € 0.76
05-2010 Finland EURO High-income 0.014 0.027 € 0.73
02-2010 France EURO High-income 0.022#1
0.021#3 0.032 € 0.76
05-2010 Germany EURO High-income 0.060-0.11 € 0.74
04-2010 Hungary EURO Upper-middle-
income
0.013 0.014 € 0.74 03-2010
India NPPA
SEARO Low-income 0.0047 INR 42.8 05-2008
Iran EMRO Lower-middle-income
0.013 IRR 9741
2008-2009 Ireland EURO High-income 0.014 € 0.70
01-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 327
Country WHO
Region World Bank Category
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0090 NA
Italy EURO High-income 0.019 € 0.74 04-2010
Jordan EMRO Lower-middle-income
0.0060 0.0076 JOD 0.70 #7 unknown
Latvia EURO Upper-middle-income
0.014 0.014 € 0.70 01-2010
Lithuania EURO Upper-middle-income
0.014#1
0.015 0.015 € 0.68
02-2008 Morocco EMRO Lower-middle-
income 0.023-0.032 0.023 MAD 7.69 #7
unknown Netherlands EURO High-income 0.0074-0.012 0.0074 € 0.76
05-2010 New Zealand WPRO High-income 0.012#1 NZ$ 1.38
05-2010 Norway EURO High-income 0.016
0.034-0.12 0.034 NOK 6.05
05-2010 Oman EMRO Upper-middle-
income 0.0041#6
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.047 € 0.63 07-2008
Portugal EURO High-income 0.0090 #4 0.013 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.014#1 0.015 € 0.69 09-2008
Slovenia EURO High-income 0.013#1 0.014 0.027 € 0.74 12-2008
South Africa AFRO Upper-middle-income
0.013#1
0.015 ZAR 7.32
04-2010 Spain EURO High-income 0.013#1
0.021 € 0.76
05-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 328
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price
#5 : VAT/GST unknown, unknown if it is included in price
#6 : VAT/GST unknown, unknown if it is included in price
#7 : Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Country WHO Region
World Bank Category
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0090 NA
Sudan EMRO Low-income 0.019#1
NA
2009 United Kingdom NHS eMIT
EURO High-income 0.0078#1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland
EURO High-income 0.011 £ 0.66 04/05-2010
United Kingdom Drug Tariff England&Wales
EURO High-income 0.026 £ 0.66 04/05-2010
All WHO Regions n = 33
n = 8 n = 4 n = 10 n = 11 n = 21 Median Price 0.013 0.016 0.014 NA 0.019
Mean Price 0.014 0.026 0.014 NA 0.021 Lowest Price 0.012 0.0078 0.0060 0.0074 0.0041 Highest Price 0.022 0.065 0.016 0.12 0.080 High/Low Ratio 1.8 8.3 2.7 16.2 19.5
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 329
Table 74: MSH price ratio Salbutamol inhaler 100mcg/dose per country Country WHO
Region World Bank Category
Salbutamol inhaler 100mcg/dose Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0090
Australia
WPRO High-income 8.33-10.2#2
Austria EURO High-income 1.44#1
1.56 3.00
Bahrain EMRO High-income 2.67#5 Brazil AMRO Upper-middle-
income 1.44#1
Canada AMRO High-income 3.22
Czech Republic EURO High-income 1.44#1
Denmark EURO High-income 7.22 #1
8.89-10.0 8.89
Finland EURO High-income 1.56 3.00 France EURO High-income 2.44#1
2.33#3 3.56
Germany EURO High-income 6.67-12.2 Hungary EURO Upper-middle-
income
1.44 1.56
India NPPA
SEARO Low-income 0.52
Iran EMRO Lower-middle-income
1.44
Ireland EURO High-income 1.56 Italy EURO High-income 2.11 Jordan EMRO Lower-middle-
income 0.67 0.84
Latvia EURO Upper-middle-income
1.56 1.56
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 330
Country WHO Region
World Bank Category
Salbutamol inhaler 100mcg/dose Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0090
Lithuania EURO Upper-middle-income
1.56#1
1.67 1.67
Morocco EMRO Lower-middle-income
2.56-3.56 2.56
Netherlands EURO High-income 0.82-1.33 0.82 New Zealand WPRO High-income 1.33# Norway EURO High-income 1.78
3.78-13.3 3.78
Oman EMRO Upper-middle-income
0.46#6
Poland EURO Upper-middle-income
5.22
Portugal EURO High-income 1.00 #4 1.44 Slovakia EURO Upper-middle-
income 1.56#1 1.67
Slovenia EURO High-income 1.44#1 1.57 3.00 South Africa AFRO Upper-middle-
income 1.44#1
1.67
Spain EURO High-income 1.44#1
2.33
Sudan EMRO Low-income 2.11#1
United Kingdom NHS eMIT
EURO High-income 0.87#1
United Kingdom Drug Tariff Scotland
EURO High-income 1.22
United Kingdom Drug Tariff England&Wales
EURO High-income 2.89
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 331
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price
#4 : Reimbursement is 69% of Retail/Patient Price
#5 : VAT/GST unknown, unknown if it is included in price
#6 : VAT/GST unknown, unknown if it is included in price
All WHO Regions n = 33
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
n = 9 n = 4 n = 10 n = 11 n = 21 Median Ratio 1.44 1.78 1.56 NA 2.11 Mean Ratio 1.57 2.91 1.50 NA 2.33 Lowest Ratio 1.33 0.87 0.67 0.82 0.46 Highest Ratio 2.44 7.22 1.78 13.3 8.89 High/Low Ratio 1.8 8.3 2.7 16.2 19.5
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 332
Table 75: AFRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region AFRO n = 1
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.013#1 1.44#1 0.015 1.67 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 333
Table 76: AMRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region AMRO n = 2
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.013#1 1.44#1 Canada 0.029 3.22 n = 0 n = 1 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 334
Table 77: EMRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region EMRO n = 6
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.024#2 2.67#2 Iran 0.013 1.44
Jordan 0.0060 0.667 0.0076 0.844 Morocco 0.023-
0.032 2.56-3.56
0.023 2.56
Oman 0.0041#2
0.456#2
Sudan 0.019#1 2.11#1 n = 0 n = 1 n = 1 n = 1 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.013 1.44 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.014 1.59 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.0041 0.456 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.024 2.67 High/Low Ratio NA NA NA NA NA NA NA NA 5.9 5.9 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 335
Table 78: EURO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region EURO n = 21
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.013#1 1.44#1 0.014 1.56 0.027 3.00 Czech Republic 0.013#1 1.44#1 Denmark 0.065#1 7.22 #1 0.080-
0.090 8.89-10.0
0.080 8.89
Finland 0.014 1.56 0.027 3.00 France 0.022#1 2.44#1 0.021#2 2.33#2 0.032 3.56 Germany 0.060-
0.11 6.67-12.2
Hungary 0.013 1.44 0.014 1.56 Ireland 0.014 1.56 Italy 0.019 2.11 Latvia 0.014 1.56 0.014 1.56 Lithuania 0.014#1 1.56#1 0.015 1.67 0.015 1.67 Netherlands 0.0074-
0.012 0.82-1.33
0.0074 0.82
Norway 0.016 1.78 0.034-0.12
3.78-13.3
0.034 3.78
Poland 0.047 5.22 Portugal 0.0093 1.00#3 0.013 1.44 Slovakia 0.014#1 1.56#1 0.015 1.67 Slovenia 0.013#1 1.44#1 0.014 1.56 0.027 3.00 Spain 0.013#1 1.44#1 0.021 2.33 United Kingdom NHS eMIT
0.0078#1
0.87#1
United Kingdom Drug Tariff Scotland
0.011 1.22
United Kingdom Drug Tariff England&Wales
0.026 2.89
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 336
WHO Region EURO n = 21
Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
n = 7 n = 2 n = 8 n = 8 n = 15 Median Price/Ratio 0.013 1.44 NA NA 0.014 1.56 NA NA 0.021 2.33 Mean Price/Ratio 0.015 1.62 0.036 4.04 0.014 1.58 NA NA 0.026 2.93 Lowest Price/Ratio 0.013 1.44 0.0078 0.87 0.013 1.44 0.0074 0.82 0.0074 0.82 Highest Price/Ratio 0.022 2.44 0.065 7.22 0.016 1.78 0.12 13.3 0.080 8.89 High/Low Ratio 1.7 1.7 8.3 8.3 1.2 1.2 16.2 16.2 10.8 10.8 #1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price #3 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 337
Table 79: SEARO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region SEARO n = 1
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India NPPA
0.0047 0.522
n = 0 n = 0 n = 0 n = 0 n = 1 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 338
Table 80: WPRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region WPRO n = 2
Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.075-
0.092#2 8.33-10.2#2
New Zealand 0.012#1 1.33#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 339
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 340
ANNEX XX: Simvastatin 20mg cap/tab Table 81: Prices Simvastatin 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO
Region World Bank Category
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0629 (only IDA) NA
Australia
WPRO High-income 1.02#2
AU$ 1.09
05-2010 Austria EURO High-income 0.23#1
0.27 0.38 € 0.74
03-2010 Belgium EURO High-income 0.068 - 0.11 #3 € 0.74
03-2010 Brazil AMRO Upper-middle-
income 0.028 #1
BRL 1.68
04-2008 Canada AMRO High-income 1.00
CA$ 1.01
04-2010 Czech Republic EURO High-income 0.29 € 0.76
04-2009 Denmark EURO High-income 0.0057 #1
0.045 - 0.098 0.045 € 0.76
05-2010 Finland EURO High-income 0.014 0.027 € 0.73
02-2010 France EURO High-income 0.37#1
0.33 #4 0.51 € 0.76
05-2010 Germany EURO High-income 0.41-0.65 € 0.74
04-2010 Hungary EURO Upper-middle-
income 0.23#1 0.27 0.38 € 0.74
03-2010 Iran EMRO Lower-middle-
income 0.10
IRR 9741 2008-2009
Ireland EURO High-income 0.94 € 0.70 01-2010
Italy EURO High-income 0.22 € 0.74 04-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 341
Country WHO Region
World Bank Category
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0629 (only IDA) NA
Jordan EMRO Lower-middle-income
0.45 0.56 JOD 0.70 #9 unknown
Latvia EURO Upper-middle-income
0.12 0.16 € 0.70 01-2010
Lebanon EMRO Upper-middle-income
0.55 #7
LBP 1489 03-2010
Lithuania EURO Upper-middle-income
0.24#1
0.26 0.31 € 0.68
02-2008 Morocco EMRO Lower-middle-
income 0.33 - 0.69 0.33 MAD 7.69 #9
unknown Netherlands EURO High-income 0.015 - 0.077 0.015 € 0.76
05-2010 New Zealand WPRO High-income 0.024#1 NZ$ 1.38
05-2010 Norway EURO High-income 0.29 0.22 - 0.23 0.35 NOK 6.05
05-2010 Oman EMRO Upper-middle-
income 0.54#8
OMR 0.38 04-2010
Poland EURO Upper-middle-income
0.27 € 0.63 07-2008
Portugal EURO High-income 0.29-0.32 #5 0.47 € 0.74 04-2010
Slovakia EURO Upper-middle-income
0.14#1 0.21 € 0.69 09-2008
Slovenia EURO High-income 0.36 € 0.74 12-2008
South Africa AFRO Upper-middle-income
0.10#1
0.14 ZAR 7.32
04-2010 Spain EURO High-income 0.094#1
0.15 € 0.76
05-2010 Country WHO World Bank Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 342
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if included
#7: VAT 10%, unknown if included; pharmacist margin US$ 0.0155, unknown if it is included in price #8 : VAT/GST unknown, unknown if it is included in price
#9: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
Region Category Ex-factory / Manufacturer
Procurement Wholesale Reimburse-ment
Retail / Patient
used ($1,00=x) Price date
MSH reference price (2008)
NA NA 0.0629 (only IDA) NA
Sudan EMRO Low-income 0.070#1
NA
2009 Sweden EURO High-income 0.016 0.062 SEK 7.19
05-2010 Tunisia EMRO Lower-middle-
income 0.47 TND 1.22 #9
unknown United Kingdom NHS eMIT
EURO High-income 0.015#1
£ 0.66
04/05-2010 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 0.061 £ 0.66 04/05-2010
United States Veterans Affairs
AMRO High-income 0.060#1
NA
2009-2010 United States MEDICAID
AMRO High-income 0.21#6 NA 2009-2010
United States Kentucky MEDICAID
AMRO High-income 0.17#6 NA 2009-2010
All WHO Regions n = 37
n = 8 n = 5 n = 11 n = 13 n = 22 Median Price 0.19 0.028 0.27 NA 0.30
Mean Price 0.18 0.036 0.28 NA 0.29 Lowest Price 0.024 0.0057 0.014 0.015 0.015 Highest Price 0.37 0.070 0.94 1.02 0.56 High/Low Ratio 15.4 12.3 67.1 68.0 37.3
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 343
Table 82: MSH price ratio Simvastatin 20mg cap/tab per country Country WHO
Region World Bank Category
Simvastatin 20mg - MSH price ratio Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0629 = 1.00
Australia
WPRO High-income 16.2#2
Austria EURO High-income 3.66#1
4.29 6.04
Belgium EURO High-income 1.08 - 1.75 #3 Brazil AMRO Upper-middle-
income 0.45#1
Canada AMRO High-income 15.9
Czech Republic EURO High-income 4.61 Denmark EURO High-income 0.091 #1
0.72 - 1.56 0.72
Finland EURO High-income 0.22 0.43 France EURO High-income 5.88#1
5.25 #4 8.11
Germany EURO High-income 6.52 -10.3 Hungary EURO Upper-middle-
income 3.66#1 4.29 6.04
Iran EMRO Lower-middle-income
1.59
Ireland EURO High-income 14.9 Italy EURO High-income 3.50 Jordan EMRO Lower-middle-
income 7.15 8.90
Latvia EURO Upper-middle-income
1.91 2.54
Lebanon EMRO Upper-middle-income
8.74 #7
Lithuania EURO Upper-middle-income
3.82#1
4.13 4.93
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 344
Country WHO Region
World Bank Category
Simvastatin 20mg - MSH price ratio Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0629 = 1.00
Morocco EMRO Lower-middle-income
5.25 - 10.9 5.25
Netherlands EURO High-income 0.24 - 1.22 0.24 New Zealand WPRO High-income 0.38#1 Norway EURO High-income 4.61 3.50 - 3.66 5.56 Oman EMRO Upper-middle-
income 8.59#8
Poland EURO Upper-middle-
income 4.29
Portugal EURO High-income 4.61 – 5.09 #5 7.31 Slovakia EURO Upper-middle-
income 2.23#1 3.34
Slovenia EURO High-income 5.72 South Africa AFRO Upper-middle-
income 1.59#1
2.23
Spain EURO High-income 1.49#1
2.38
Sudan EMRO Low-income 1.11#1
Sweden EURO High-income 0.25 0.99 Tunisia EMRO Lower-middle-
income 7.47
United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
EURO High-income 0.970
United Kingdom NHS eMIT
EURO High-income 0.24#1
United States Veterans Affairs
AMRO High-income 0.95#1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 345
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price
#6 : VAT/GST varies throughout states in USA, unknown if it is included in price
#7: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #8 : VAT/GST unknown, unknown if it is included in price
Country WHO Region
World Bank Category
Simvastatin 20mg - MSH price ratio Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
MSH reference price (2008)
NA NA 0.0629 = 1.00
United States MEDICAID
AMRO High-income 3.34#6
United States Kentucky MEDICAID
AMRO High-income 2.70#6
All WHO Regions n = 37
n = 8 n = 5 n = 11 n = 13 n = 22 Median Ratio 2.94 0.45 4.29 NA 4.77 Mean Ratio 2.84 0.57 4.52 NA 4.65 Lowest Ratio 0.38 0.091 0.22 0.24 0.24 Highest Ratio 5.88 1.11 14.9 16.2 8.90 High/Low Ratio 15.4 12.3 67.1 68.0 37.3
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 346
Table 83: AFRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.10#1 1.59#1 0.14 2.23 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 347
Table 84: AMRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.028#1 0.45#1 Canada 1.00 12.9 United States Veterans Affairs
0.060#1 0.95#1
United States MEDICAID
0.21#2 3.34#2
United States Kentucky MEDICAID
0.17#2 2.70#2
n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.47 0.67 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.028 0.45 NA NA 0.17 2.70 NA NA Highest Price/Ratio NA NA 0.060 0.95 NA NA 1.00 12.9 NA NA High/Low Ratio NA NA 2.1 2.1 NA NA 5.9 5.9 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 348
Table 85: EMRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Iran 0.10 1.59 Jordan 0.45 7.15 0.56 8.90 Lebanon 0.55#2 8.74#2 Morocco 0.33-
0.69 5.25-10.9
0.33 5.25
Oman 0.54#3 8.59#3 Sudan 0.070#1 1.11#1 Tunisia 0.47 7.47 n = 0 n = 1 n = 1 n = 1 n = 6 Median Price/Ratio NA NA NA NA NA NA NA NA 0.51 8.03 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.43 6.76 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.10 1.59 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.56 8.90 High/Low Ratio NA NA NA NA NA NA NA NA 5.6 5.6 #1 : INCO-term unknown #2: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #3 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 349
Table 86: EURO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.23#1 3.66#1 0.27 4.29 0.38 6.04 Belgium 0.068 -
0.11#2 1.08 - 1.75#2
Czech Republic 0.29 Denmark 0.0057
#1 0.091#1 0.045 -
0.098 0.72 -1.56
0.045 0.72
Finland 0.014 0.22 0.027 0.43 France 0.37#1 5.88#1 0.33#3 5.25#3 0.51 8.11 Germany 0.41 -
0.65 6.52 - 10.3
Hungary 0.23#1 3.66#1 0.27 4.29 0.38 6.04 Ireland 0.94 14.9 Italy 0.22 3.50 Latvia 0.12 1.91 0.16 2.54 Lithuania 0.24#1 3.82#1 0.26 4.13 0.31 4.93 Netherlands 0.015 -
0.077 0.24 - 1.22
0.015 0.24
Norway 0.29 4.61 0.22 - 0.23
3.50 - 3.66
0.35 5.56
Poland 0.27 4.29 Portugal 0.29 -
0.32#4 4.61-5.09#4
0.46 7.31
Slovakia 0.14#1 2.23#1 0.21 3.34 Slovenia 0.36 5.72 Spain 0.094#1 1.49#1 0.15 2.38 Sweden 0.016 0.25 0.062 0.99 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales
0.061 0.97
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 350
United Kingdom NHS eMIT
0.015#1 0.24#1
WHO Region EURO n = 22
Ex-factory / Manufacturer
Procurement Wholesale Reimburse- ment
Retail / Patient
n = 6 n = 2 n = 9 n = 8 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio
Median Price/Ratio 0.23 3.66 NA NA 0.27 4.29 NA NA 0.25 3.90 Mean Price/Ratio 0.22 3.46 0.010 0.17 0.28 4.49 NA NA 0.24 3.85 Lowest Price/Ratio 0.094 1.49 0.0057 0.091 0.014 0.22 0.015 0.24 0.015 0.24 Highest Price/Ratio 0.37 5.88 0.015 0.24 0.94 14.9 0.65 10.3 0.51 8.11 High/Low Ratio 3.9 3.9 2.6 2.6 67.1 67.1 43.3 43.3 34.0 34.0
#1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 351
Table 87: SEARO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 0
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio n = 0 n = 0 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 352
Table 88: WPRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2
Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer
Procurement Wholesale Reimbursement Retail / Patient
Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 1.02#2 16.2#2 New Zealand 0.024#1 0.38#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA
#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 353
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 354
ANNEX XXI: Atorvastatin 20mg cap/tab Table 89: Prices Atorvastatin 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes) All prices listed are for Pfizer brands (Lipitor, Sortis, Tahor, Torvast; unless otherwise stated) Country WHO
Region World Bank Category
Atorvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer Pfizer
Procurement Pfizer
Wholesale Pfizer
Reimburse-ment Pfizer
Retail / Patient Pfizer/ Generic
MSH reference price (2008)
No MSH reference price available: reference is country price Simvastatin 20mg (see specifications in price ratio table)
Australia
WPRO High-income 1.02#2
Lipitor AU$ 1.09
05-2010 Austria EURO High-income 1.49#1
Sortis 1.64
Sortis 2.09
Sortis € 0.74 03-2010
Canada PAHO High-income 1.89 Lipitor
CA$ 1.01 04-2010
Czech Republic EURO High-income 1.99 Sortis 0.43 Generic
€ 0.76 04-2009
Denmark EURO High-income 1.22#1
Lipitor 1.26-1.40
Lipitor 1.28
Lipitor € 0.76 05-2010
Finland EURO High-income 0.85 Lipitor
1.18 Lipitor 0.41 Generic
€ 0.73 02-2010
Germany EURO High-income 0.46-0.71 Sortis
€ 0.74 04-2010
Hungary EURO Upper-middle-income
0.67 Generic
€ 0.74 03-2010
Ireland EURO High-income 1.83 Lipitor
€ 0.70 01-2010
Italy EURO High-income 1.89 Torvast
€ 0.74 04-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 355
Country WHO Region
World Bank Category
Atorvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer Pfizer
Procurement Pfizer
Wholesale Pfizer
Reimburse-ment Pfizer
Retail / Patient Pfizer/ Generic
MSH reference price (2008)
No MSH reference price available: reference is country price Simvastatin 20mg (see specifications in price ratio table)
Jordan EMRO Lower-middle-income
1.87 Lipitor
2.36 Lipitor 1.09 Generic
JOD 0.70 #7 unknown
Latvia EURO Upper-middle-income
0.66 Sortis
0.79 Sortis 0.29 Generic
€ 0.70 01-2010
Lebanon EMRO Upper-middle-income
2.12#5 Lipitor 0.89#5 Generic
LBP 1489 03-2010
Lithuania EURO Upper-middle-income
1.38#1
Sortis
1.46 Sortis
1.51 Sortis 0.62 Generic
€ 0.68 02-2008
Morocco EMRO Lower-middle-income
1.09-1.15 Tahor
1.09 Tahor
MAD 7.69 #7 unknown
Netherlands EURO High-income 1.35 Lipitor
1.35 Lipitor
€ 0.76 05-2010
New Zealand WPRO High-income 0.11#3 Lipitor
NZ$ 1.38 05-2010
Norway EURO High-income 1.28 Lipitor
0.30#4 Lipitor
1.30#4 Lipitor
NOK 6.05 05-2010
Oman EMRO Upper-middle-income
3.14#6
Lipitor
1.48#6 Generic
OMR 0.38 04-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 356
Country WHO Region
World Bank Category
Atorvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date
Ex-factory / Manufacturer Pfizer
Procurement Pfizer
Wholesale Pfizer
Reimburse-ment Pfizer
Retail / Patient Pfizer/ Generic
MSH reference price (2008)
No MSH reference price available: reference is country price Simvastatin 20mg (see specifications in price ratio table)
Poland EURO Upper-middle-income
0.34 Generic
€ 0.63 07-2008
Slovakia EURO Upper-middle-income
1.51#1 Sortis
1.94 Sortis 0.52 Generic
€ 0.69 09-2008
Slovenia EURO High-income 1.16 Sortis
€ 0.74 12-2008
South Africa AFRO Upper-middle-income
1.06#1
Lipitor 1.13
Lipitor ZAR 7.32
04-2010 Spain EURO High-income 1.50
Lipitor € 0.76 05-2010
Sweden EURO High-income 1.66 Lipitor
1.75 Lipitor
SEK 7.19 05-2010
Tunisia EMRO Lower-middle-income
1.31 Tahor 0.93 Generic
TND 1.22 #7 unknown
United Kingdom Drug Tariff England&Wales
EURO High-income 1.33
Lipitor £ 0.66
04/05-2010
United States Veterans Affairs
AMRO High-income 2.73#1
Lipitor NA
2009-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 357
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursed amount for New Zealand is exclusive of 0.50 US$ co-payment per tablet #4 : Difference between retail/patient price and reimbursed amount is co-payment
#5 : VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price #7: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
All WHO Regions n = 29
n = 5 n = 2 n = 10 n = 8 n = 17 Pfizer
n = 11 Generic
Median Price 1.38 --- 1.37 --- 1.51 0.62 Mean Price 1.11 1.98 1.35 --- 1.68 0.70 Lowest Price 0.11 1.22 0.66 0.30 0.79 0.29 Highest Price 1.51 2.73 1.87 1.89 3.14 1.48 High/Low Ratio 13.7 2.24 2.8 6.3 4.0 5.1
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 358
Table 90: Country price ratio Atorvastatin 20mg cap/tab per country (SMV = Simvastatin; ATV = Atorvastatin) Country WHO
Region Atorvastatin 20mg – Country price ratio (Country price ATV/Country price SMV) Ex-factory / Manufacturer Prices
Ratio
Procurement Prices
Ratio
Wholesale Prices
Ratio
Retail / Patient Prices Pfizer
Ratio Pfizer
Retail / Patient Prices generic
Ratio generic
SMV ATV SMV ATV SMV ATV SMV ATV ATV Austria EURO 0.23#1 1.49#1 6.48 0.27 1.64 6.07 0.38 2.09 5.50 Czech Republic
EURO 0.29 1.99 6.86 0.43 1.48
Denmark EURO 0.0057#1 1.22#1 214.0 0.045 1.28 28.4 Finland EURO 0.014 0.85 60.7
0.027 1.18
43.7
0.41
15.19
Hungary EURO 0.38 0.67 1.76 Ireland EURO 0.94 1.83 1.95 Italy EURO 0.22 1.89 8.59 Jordan EMRO 0.45 1.87 4.16 0.56 2.36 4.21 1.09 1.95 Latvia EURO 0.12 0.66 5.50 0.16 0.79 4.94 0.29 2.31 Lebanon EMRO 0.55#2 2.12#2 3.85 0.89#2 1.62 Lithuania EURO 0.24#1 1.38#1 5.75 0.26 1.46 5.62 0.31 1.51 4.87 0.62 2.00 Morocco EMRO 0.33 1.09 3.30 Nether-lands
EURO 0.015 1.35 90.0
New Zealand
WPRO 0.024#1 0.11#1 4.58
Norway EURO 0.29 1.28 4.41 0.35 1.30#3 3.71 Oman EMRO 0.54#4 3.14#4 5.81 1.48#4 2.74 Poland EURO 0.27 0.34 1.26 Slovakia EURO 0.14#1 1.51#1 10.8 0.21 1.94 9.24 0.52 2.48 Slovenia EURO 0.36 1.16 3.22 South Africa
AFRO 0.10#1 1.06#1 10.6 0.14 1.13 8.07
Spain EURO 0.15 1.50 10.0 Sweden EURO 0.016 1.66 103.8 0.062 1.75 28.2 Tunisia EMRO 0.47 1.31 2.79 0.93 1.98
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 359
United States Veterans Affairs
AMRO 0.060#1 2.73#1 45.5
All WHO Regions n = 25
Ex-factory Procurement Wholesale Retail/patient Pfizer Retail/patient generic
n = 5 n = 2 n = 10 n = 18 n = 11 Median Ratio
6.48 --- 5.56 5.66 1.98
Mean Ratio
7.64 129.8 20.4 14.8 3.16
Lowest Ratio
4.58 45.5 1.95 2.79 1.26
Highest Ratio
10.8 214.0 103.8 90.0 15.2
High/Low Ratio
2.4 4.7 53.2 32.3 12.1
SMV = Simvastatin; ATV = Atorvastatin (Lipitor, Sortis, Tahor, Torvast or generic for retail/patient prices) #1 : INCO-term unknown
#2: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #3 : Retail/patient price is exclusive of US$ 1.00 co-payment per tablet #4 : VAT/GST unknown, unknown if it is included in price
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 360
ANNEX XXII: Esomeprazole 20mg cap/tab Table 91: Prices Esomeprazole 20mg cap/tab per country All prices listed are for AstraZeneca brands (Nexium, Nexiam, Inexium) Country WHO
Region World Bank Category
Esomeprazole 20mg (prices in US$ per cap/tab, excl taxes)
Exchange rate used ($1,00=x) Price date Ex-factory /
Manufacturer Procurement Wholesale Reimburse-
ment Retail / Patient
MSH reference price (2008)
No MSH reference price available: reference is country price Omeprazole 20mg (see specifications in price ratio table)
Australia
WPRO High-income 1.02#2
Nexium AU$ 1.09
05-2010 Austria EURO High-income 1.05#1
Nexium 1.19
Nexium 1.61
Nexium € 0.74 03-2010
Bahrain EMRO High-income 2.30#5 Nexium
BHD 0.37#6 unknown
Belgium EURO High-income 0.26-0.39#3 Nexiam
€ 0.74 03-2010
Czech Republic EURO High-income 1.11#1
Nexium 1.40
Nexium € 0.76 04-2009
Denmark EURO High-income 0.89#1
Nexium 0.88-1.13
Nexium 0.92 Nexium
€ 0.76 05-2010
Finland EURO High-income 0.81 Nexium
1.14 Nexium
€ 0.73 02-2010
Germany EURO High-income 0.91-1.45 Nexium
€ 0.74 04-2010
Hungary EURO Upper-middle-income
0.81#1 Nexium
0.85 Nexium
1.00 Nexium
€ 0.74 03-2010
Ireland EURO High-income 1.41 Nexium
€ 0.70 01-2010
Jordan EMRO Lower-middle-income
1.26 Nexium
1.59 Nexium
JOD 0.70#6 unknown
Morocco EMRO Lower-middle-income
1.76 Nexium
MAD 7.69#6 unknown
Netherlands EURO High-income 0.88 Nexium
0.88 Nexium
€ 0.76 05-2010
Norway EURO High-income 0.74 Nexium
0.77 Nexium
0.77 Nexium
NOK 6.05 05-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 361
Country WHO
Region World Bank Category
Esomeprazole 20mg (prices in US$ per cap/tab, excl taxes)
Exchange rate used ($1,00=x) Price date Ex-factory /
Manufacturer Procurement Wholesale Reimburse-
ment Retail / Patient
MSH reference price (2008)
No MSH reference price available: reference is country price Omeprazole 20mg (see specifications in price ratio table)
Oman EMRO Upper-middle-income
1.69#5
Nexium OMR 0.38 04-2010
Portugal EURO High-income 0.74#4 Nexium
1.09 Nexium
€ 0.74 04-2010
Slovakia EURO Upper-middle-income
1.17#1 Nexium
1.53 Nexium
€ 0.69 09-2008
Slovenia EURO High-income 0.85#1
Nexium 0.92
Nexium 0.98
Nexium € 0.74 12-2008
South Africa AFRO Upper-middle-income
1.10#1
Nexiam 1.14
Nexiam ZAR 7.32
04-2010 Spain EURO High-income 1.08#1
Nexium 1.34
Nexium € 0.76 05-2010
Sudan EMRO Low-income 0.73#1
Nexium NA
2009 Sweden EURO High-income 1.44
Nexium 1.53
Nexium SEK 7.19 05-2010
Tunisia EMRO Lower-middle-income
1.23 Nexium
TND 1.22#6 unknown
United Kingdom Drug Tariff England&Wales
EURO High-income 1.00
Nexium
£ 0.66 04/05-2010
United States Veterans Affairs
AMRO High-income 3.76#1
Nexium NA
2009-2010
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 362
#1 : INCO-term unknown
#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 69% of Retail/Patient Price
#5 : VAT/GST unknown, unknown if it is included in price
#6: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)
All WHO Regions n = 26
n = 7 n = 3 n = 9 n = 8 n = 17 Median Price 1.08 0.89 1.14 --- 1.34
Mean Price 1.02 1.79 1.08 --- 1.34 Lowest Price 0.81 0.73 0.74 0.26 0.77 Highest Price 1.17 3.76 1.44 1.45 2.30 High/Low Ratio 1.4 5.2 1.9 5.6 3.0
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 363
Table 92: Country price ratio Esomeprazole 20mg cap/tab per country OMP = Omeprazole; EMP = Esomeprazole (Nexium or Nexiam) Country WHO
Region Esomeprazole 20mg – Country price ratio Ex-factory / Manufacturer Prices
Ratio
Procurement Prices
Ratio
Wholesale Prices
Ratio
Retail / Patient Prices
Ratio
OMP EMP OMP EMP OMP EMP OMP EMP Austria EURO 0.36#1 1.05#1 2.92 0.41 1.19 2.90 0.55 1.61 2.93 Bahrain EMRO 0.69#2 2.30#2
3.33
Czech Republic
EURO xx 1.11#1
xx 0.24 1.40
5.83
Denmark EURO 0.0631 0.89#1 14.1 0.076 0.92 12.1 Finland EURO 0.15 0.81 5.40 0.26 1.14 4.38 Hungary EURO 0.47#1 0.81#1 1.72 0.50 0.85 1.70 0.61 1.00 1.64 Ireland EURO 1.07 1.41 1.32 Jordan EMRO 0.54 1.26 2.33 0.68 1.59 2.34 Morocco EMRO 0.31 1.76 5.68 Nether- lands
EURO 0.033 0.88 26.7
Norway EURO 0.20 0.74 3.70 0.24 0.77 3.21 Oman EMRO 0.39#2 1.69#2 4.33 Portugal EURO 0.63 1.11 1.76 Slovakia EURO 0.11#1 1.17#1 10.6 0.17 1.53 9.00 Slovenia EURO xx 0.85#1 xx 0.54 0.92 1.70 xx 0.98 xx South Africa
AFRO 0.45#1 1.10#1 2.44 0.61 1.14 1.87
Spain EURO 0.089#1 1.08#1
12.1 0.14 1.34
9.57
Sudan EMRO 0.16#1 0.73#1 4.56 Sweden EURO 0.035 1.44 41.1 0.076 1.53 20.1 Tunisia EMRO 0.58 1.23 2.12 United States Veterans Affairs
AMRO 0.14#1 3.76#1 28.9
Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 364
All WHO Regions n = 21
Ex-factory Procurement Wholesale Retail/Patient n = 5 n = 3 n = 9 n = 16
Median Ratio
2.92 14.1 2.33 4.36
Mean Ratio
5.96 15.9 6.89 7.19
Lowest Ratio
1.72 4.56 1.32 1.64
Highest Ratio
12.1 28.9 41.1 26.7
High/Low Ratio
7.0 6.3 31.1 16.3
#1 : INCO-term unknown
#2 : VAT/GST unknown, unknown if it is included in price