Price and affordability of key essential medicines for children in Sri Lanka, a lower-middle-income country: comparison of two national cross-sectional surveys done 8 years apart

Abstract

ObjectiveTo describe the price and affordability of key essential medicines for children in the private sector in Sri Lanka in 2017/2018, and compare the findings with 2009 data.DesignNational cross-sectional descriptive survey using the WHO/Health Action International medicine price methodology.Setting and participantsData were collected from a representative sample of 54 private sector pharmacies selected from all 9 provinces in Sri Lanka using a multistage clustered approach.Main outcomesMedian price ratio (MPR) and affordability of originator brand (OB) and lowest priced generics (LPG) of 25 key essential medicines for children.ResultsThe median MPR was 2.69 for OBs and 1.45 for LPGs compared with 3.7 and 1.35 in 2009. MPR of OB of all but one (chlorphenamine syrup) were higher than that of the LPG. MPR-OB>5 was observed for ceftriaxone injection, amoxicillin capsule, mebendazole chewable tablet and metronidazole tablet. This was documented in 2009 as well except for amoxicillin capsule. Prices of LPGs of seven medicines (amoxicillin capsule, amoxicillin suspension, clotrimazole cream, mebendazole chewable tablet, metronidazole tablet) were estimated as excessive (MPR ≥2.5) compared with chlorphenamine syrup, clotrimazole topical cream, ibuprofen syrup and paracetamol syrup in 2009. Compared with 2009, MPRs of OBs of 8 medicines and LPGs of 12 medicines were higher in 2017/2018. Compared with 2009, no change in affordability was noted except for asthma, which has been assessed as affordable in 2017/2018. Standard drug therapy for mild lower respiratory tract infections and acute gastroenteritis remained affordable, and treating epilepsy with carbamazepine syrup remained unaffordable.ConclusionEconomic access to key essential medicines for children has not improved in Sri Lanka in the 8 years’ time since the initial survey in 2009.

Affordability of Paediatric Oral Anti-Infective Medicines in a Selected District, Sri Lanka

“…The main study conducted in Sri Lanka, prior to the present study on the affordability of oral paediatric anti-infective medicinal drugs, was the "National Survey of Price and Affordability of Key Essential Medicines for Children in Sri Lanka", which was conducted in 2009 and repeated in 2018/2019 [6,30]. Table 4 compares the MPRs of OB and LPG for selected essential anti-infective medicinal drugs.…”

“…In addition, the MPRs of the LPG containing amoxicillin and amoxicillin and clavulanic acid increased, whereas the MPRs of the LPG containing dicloxacillin and erythromycin decreased from 2009 to 2021. However, all three medications (amoxicillin, amoxicillin and clavulanic acid, and erythromycin) reduced the MPR for LPG from 2018/2019 to 2021 [6,30]. One possible reason for this may be the recently introduced maximum retail price control.…”

“…The salary adjustment aimed to align with the inflation rate in Sri Lanka, addressing the prior period of a fixed public pay scale. The cost of standard treatment with both OB and LPG of amoxicillin has decreased by half since 2018/2019 in Sri Lanka (compared with the national survey in 2018/2019) [30] (Table 6). This was observed despite amoxicillin not being a price-controlled medicine in Sri Lanka.…”

“…The standard treatment of amoxicillin was still affordable for workers with the lowest salary in the private sector. A national survey in 2009 and 2018/2019 did not analyse the affordability of treatment with oral paediatric anti-infective medicinal drugs against the lowest daily salary of the private sector stipulated by law [6,30]. Therefore, any direct comparison of the affordability of standard treatment with oral paediatric anti-infective medicinal drugs in the national survey of 2009 and 2018/2019 was limited to the affordability against the lowest daily salary of an unskilled public employee.…”