Availability, prices and affordability of essential medicines for children: a cross-sectional survey in Jiangsu Province, China

Sun, Xiaoluan; Wei, Jing; Yao, Yuan; Chen, Qiutong; You, Daiting; Xu, Xiaotong; Dai, Jing; Yao, Yanping; Sheng, Jingyi; Li, Xin

doi:10.1136/bmjopen-2018-023646

Cited by 26 publications

(37 citation statements)

References 20 publications

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“…Concerning substantially higher prices in private sectors compared to public sectors, this nding is similar to the studies done by Edao Sado and Alemu Sufa, and Sun X et al 17,28 A noticeable price variability between both sectors was common for captured medicine in this study. It is consistent with a study undertaken on the availability, prices, and affordability of essential medicines in Ethiopia, Haiti, and china 17,22,28 Managing commonly prevalent conditions-acute and chronic-with standard treatment protocol using the lowestpriced medicines in the region was unaffordable (81.82% in public and 91.91% in private) as they cost a day's or above wage for the LPGW. This nding agrees with the ndings of Edao Sado and Alemu Sufa, and Sun X et al 17,28 The assumption of the LPGW method to assess the affordability of EMs is that all wages go for medicine purchasing.…”

Section: Discussionsupporting

confidence: 91%

“…It is consistent with a study undertaken on the availability, prices, and affordability of essential medicines in Ethiopia, Haiti, and china 17,22,28 Managing commonly prevalent conditions-acute and chronic-with standard treatment protocol using the lowestpriced medicines in the region was unaffordable (81.82% in public and 91.91% in private) as they cost a day's or above wage for the LPGW. This nding agrees with the ndings of Edao Sado and Alemu Sufa, and Sun X et al 17,28 The assumption of the LPGW method to assess the affordability of EMs is that all wages go for medicine purchasing. For households that have an average of 4.6 children, spending a day's wage for purchasing medicine only is not evident.…”

Section: Discussionsupporting

confidence: 83%

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Availability and Affordability of Children Essential Medicines in Health Facilities of Southern Nations, Nationalities, And People Region, Ethiopia: Key Determinants for Access.

Tadesse

Abuye

Tilahun

2020

Preprint

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Background: Children in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples’ regions (SNNPR), Ethiopia. Method: A medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected EMs for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The number of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EDs. Results: Availability was varied by sectors, type of medicines, and level of health facilities. The average availability of EMs was 57.67% in the public sector and 53.67% in private sectors. Ceftriaxone, ORS, zink sulfate, and cotrimoxazole were the most widely available medicine types in both sectors. The median price ratios (MPR) for lowest-priced (LP) medicines were 1.26 and 2.24 times higher than their international reference price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and ninety-one percent of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day’s or more wages for the LPGW.Conclusion: Availability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

Availability and Affordability of Children Essential Medicines in Health Facilities of Southern Nations, Nationalities, And People Region, Ethiopia: Key Determinants for Access.

Tadesse

Abuye

Tilahun

2020

Preprint

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“…Availability in each province is reported as the percentage of outlets in which each medicine was found on the day of data collection. Most WHO/HAI surveys use the criteria of availability of medicines as follows: very low: < 30%, low: 30–49%, fairly high: 50–80%, high: > 80% ( Sharma et al, 2016 ; Kibira et al, 2017 ; Liu et al, 2017 ; Gong et al, 2018 ; Sun et al, 2018 ; Wu et al, 2018 ; Kasonde et al, 2019 ). Median unit prices (MUPs) for each medicine is calculated in RMB (yuan, ¥).…”

Section: Methodsmentioning

confidence: 99%

Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

Yang

et al. 2020

Front. Pharmacol.

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Objectives: To evaluate the price and availability of medicines in China.Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018.Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector.Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.

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“…A standardized method was developed by the World Health Organization (WHO) and Health Action International (HAI) and has been used in Malaysia, China, Pakistan, Thailand, Sri Lanka, Ethiopia, India, Malawi, Haiti, etc. Most surveys focused on the essential medicines for adults [24,25,26,27,28] and children [29,30,31,32]. Some others focused on medicines for cardiovascular patients [33,34], antidiabetics [35,36], and orphans [37,38].…”

Section: Introductionmentioning

confidence: 99%

Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

Zhu

Wang

Sun

et al. 2019

IJERPH

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Objectives: With the increasing incidence of cancer, poor access to affordable anticancer medicines has been a serious public health problem in China. To help address this issue, we assessed the availability, price and affordability of pharmacotherapy for cancer in public hospitals in the Jiangsu Province, China. Methods: In 2012 and 2016, anticancer medicine availability and price information in the capital and five other cities was collected. A total of six cancer care hospitals, 26 tertiary general hospitals and 28 secondary general hospitals were sampled, using an adaptation of the World Health Organization/Health Action International methodology. Data was collected for the anticancer medicines in stock at the time of the surveys. Prices were expressed as inflation-adjusted median unit prices (MUPs). Medicine was affordable if the overall cost of all the prescribed anticancer medicines was less than 20% of the household’s capacity to pay. We used generalized estimating equations to estimate the significance of differences in availability from 2012 to 2016 and the Wilcoxon rank test to estimate the significance of differences in MUPs. Multivariate logistic regression was computed to measure predictors of affordability. Results: From 2012 to 2016 there was a significant decrease in the mean availability of originator brands (OBs) (from 7.79% to 5.71%, p = 0.012) and lowest-priced generics (LPGs) (36.29% to 32.67%, p = 0.009). The mean availability of anticancer medicines in secondary general hospitals was significantly lower than the cancer care, as well as in tertiary general hospitals. The MUPs of OBs (difference: −21.29%, p < 0.01) and their LPGs (−22.63%, p < 0.01) decreased significantly from 2012 to 2016. The OBs (16.67%) of all the anticancer medicines were found to be less affordable than LPGs (34.62% for urban residents and 30.77% for rural residents); their affordability varied among the different income regions. From 2012 to 2016, the proportion of LPGs with low availability and low affordability dropped from 30.77% to 19.23% in urban areas and 34.62% to 26.92% in rural areas, respectively. Generic substitution and medicine covered by basic medical insurance are factors facilitating affordability. Conclusion: There were concerning decreases in the availability of anticancer medicines in 2016 from already low availability in 2012. Anticancer medicines were more affordable for the patients in high-income regions than the patients in low-income regions. Governments should consider using their bargaining power to reduce procurement prices and abolish taxes on anticancer medicines. Policy should focus on the special health insurance plan for low-income patients with cancer. The goal of drug policy should ensure that first-line generic drugs are available for cancer patients and preferentially prescribed.

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Availability, prices and affordability of essential medicines for children: a cross-sectional survey in Jiangsu Province, China

Cited by 26 publications

References 20 publications

Availability and Affordability of Children Essential Medicines in Health Facilities of Southern Nations, Nationalities, And People Region, Ethiopia: Key Determinants for Access.

Availability and Affordability of Children Essential Medicines in Health Facilities of Southern Nations, Nationalities, And People Region, Ethiopia: Key Determinants for Access.

Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

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