Availability, cost, and affordability of asthma and chronic obstructive pulmonary disease medications in The Gambia

Abstract

Objectives: Guidelines for asthma and chronic obstructive pulmonary disease (COPD) have undergone significant changes. Specifically, inhaled corticosteroids (ICSs) either alone or in combination with a long-acting beta2-agonist (LABA) are now first-line treatment for asthma, while long-acting muscarinic antagonists alone or in combination with LABAs are first-line treatment of COPD. Data on local availability, cost, and affordability of these medicines in The Gambia are unknown. Materials and Methods: We surveyed all registered pharmacists in Gambia and calculated affordability indices relative to the prevailing wage of the lowest government worker. Results: Eight out of 18 registered pharmacists responded to the survey. Respondents were responsible for stocking 19 out 26 registered pharmacies in the country, resulting in a response rate of 44%. Salbutamol inhalers were widely available, stocked by the central medical stores and 6 out of 8 surveyed pharmacists. Only one pharmacist reported stocking beclometasone 50 mcg, budesonide 100 mcg, and fluticasone propionate 125 mcg inhalers. Aminophylline was stocked by 4/8 pharmacists. The price of salbutamol 100 mcg inhaler was Gambian Dalasi (GMD) 200 (US$ 4, 4 days’ wages), while ipratropium bromide 20 mcg cost GMD 675 (US$ 14, 15 days’ wages). ICS maintenance inhalers at private pharmacies cost 15, 26, and 28 days’ wages for beclomethasone 50 mcg, fluticasone propionate 125 mcg, and budesonide 100 mcg, respectively. Combination of ICS/LABA inhaler was 26 days’ wages while tiotropium bromide 18 mcg affordability was 95 days’ wages. Conclusion: Guideline recommended medications for the management of asthma and COPD in The Gambia are unavailable, expensive, and unaffordable.

Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes

“…4 However, despite listing of budesonide-formoterol on WHO's Essential Medicines List, 95 affordable access is very limited in many low-resource settings. 1,4,93,94,96 The urgent need to ensure access to affordable quality-assured inhaled asthma medications as part of universal health coverage must now be prioritized by all relevant stakeholders, particularly manufacturers of inhalers on the WHO Essential Medicines List. 95…”

“…The safest and most effective approach to asthma treatment in adolescents and adults, which also avoids the consequences of starting treatment with SABA alone, depends on access to ICS–formoterol across all asthma severity levels ( 4 ). However, despite listing of budesonide–formoterol on WHO’s Essential Medicines List ( 95 ), affordable access is very limited in many low-resource settings ( 1 , 4 , 93 , 94 , 96 ). The urgent need to ensure access to affordable, quality-assured inhaled asthma medications as part of universal health coverage must now be prioritized by all relevant stakeholders, particularly manufacturers of inhalers on the WHO Essential Medicines List ( 95 ).…”

Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes

“…consequences of starting treatment with SABA alone, depends on access to ICS-formoterol across all asthma severity levels (4). However, despite listing of budesonide-formoterol on WHO's Essential Medicines List (95), affordable access is very limited in many low-resource settings (1,4,93,94,96). The urgent need to ensure access to affordable, quality-assured inhaled asthma medications as part of universal health coverage must now be prioritized by all relevant stakeholders, particularly manufacturers of inhalers on the WHO Essential Medicines List (95).…”

The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review

“…41,42,51 The availability of long-acting muscarinic antagonists (LAMAs) ranged from 2•3% in Nigeria to 13•0% in The Gambia. 41,46 The availability of SABA nebules ranged from 10•0% in Tanzania to 58•8% in Nigeria. 26,41 Antimuscarinic agents were not available in several countries including Benin, Eritrea, Bhutan, Viet Nam, and Ghana, but were available in 30•8% of facilities in Sri Lanka.…”

“…25,28,39 The only data on antimuscarinic nebules came from Nigeria and The Gambia, where availability ranged between 0•0% and 13•0%. 41,46 Cost was described by 12 studies. The cost of a SABA inhaler for the patient compared with the MPR ranged from 0•10 in Mozambique to 340 in Uganda.…”