University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Shaanxi, China.
PLoS One. 2019 Apr 25;14(4):e0216122. doi: 10.1371/journal.pone.0216122. eCollection 2019.
Inadequate access to medicines affected by un-controlled prices is a major concern in developing countries, including Pakistan, which lacks comprehensive data on medicine prices. Thus, the objective of this study was to evaluate the prices, availability and affordability of essential medicines in Lahore division, Pakistan. The survey was undertaken from November, 2016 till March, 2017 by including 50 medicines, 14 from the WHO/HAI core list and 36 supplementary medicines from national essential medicine list (NEML) at public (n = 16) and private (n = 16) health facilities. The prices, availability and affordability of selected medicines were measured using a variant of the WHO/HAI standard methodology available on HAI website and WHO/HAI manual. A questionnaire was used for data collection from Lahore division. The prices were compared to International reference prices (IRPs) and the daily wage of a lowest paid unskilled government worker was used to calculate medicine affordability. Data suggested poor availability of originator brands (OB) in public and private sector facilities, i.e., 6.8% and 55.0%, respectively. Similarly, low availability was observed for lowest price generics (LPGs), both in public (35.3%) and private sector (20.3%) facilities-far below the WHO global action plan targets of 80% availability of essential medicines by 2025. In private sector, 53% OB and 38% LPG medicines were found excessively priced. The cost of standard treatment with OBs was unaffordable, i.e., above a single daily wage (1.4 day's wages) was demanded to purchase the standard treatment for the selected diseases in case of OBs medicines. Whereas, the cost of LPGs medicine required to purchase the standard treatment of the selected diseases was 0.6 day's wage (median), below a single daily wage. In conclusion, access to essential medicines, especially at public sector facilities was affected by low availability, particularly of OBs in comparison to LPGs. Thus, the better availability of LPGs might be a rational basis of transition into a generic system of prescribing that may improve the availability and accessibility of essential medicines in Lahore division. Medicine prices in Lahore division were found higher in comparison to IRPs. Thus, the efforts must be made to formulate patient's pocket friendly drug pricing policy that favors price cuts and improves affordability.
在发展中国家，包括巴基斯坦在内，药品价格不受控制，导致人们无法获得所需药品，这是一个主要问题，而巴基斯坦缺乏药品价格的全面数据。因此，本研究的目的是评估巴基斯坦拉合尔地区基本药物的价格、可及性和可负担性。该调查于 2016 年 11 月至 2017 年 3 月进行，共纳入 50 种药品，其中 14 种来自世界卫生组织/卫生保健联盟核心清单，36 种来自国家基本药物清单（NEML），在公立（n=16）和私立（n=16）医疗机构中进行。采用世界卫生组织/卫生保健联盟网站和手册上提供的世界卫生组织/卫生保健联盟标准方法的变体来衡量选定药品的价格、可及性和可负担性。从拉合尔地区收集数据使用了一份问卷。将价格与国际参考价格（IRP）进行比较，并使用最低薪非熟练政府工人的日工资来计算药品的可负担性。数据表明，在公立和私立部门机构中，原研药品牌（OB）的供应情况都很差，分别为 6.8%和 55.0%。同样，在公立（35.3%）和私立（20.3%）部门机构中，最低价格仿制药（LPG）的供应情况也很低，远低于世界卫生组织到 2025 年 80%的基本药物供应目标。在私立部门，53%的 OB 和 38%的 LPG 药品价格过高。OB 标准治疗的费用难以负担，即购买所选疾病的标准治疗所需费用超过单日工资（1.4 天工资）。而购买所选疾病的 LPG 药物的标准治疗所需费用为 0.6 天工资（中位数），低于单日工资。总之，基本药物的可及性，特别是在公立部门机构，受到低供应的影响，特别是与 LPG 相比，OB 的供应更少。因此，更好地供应 LPG 可能是向开处方的通用系统过渡的合理基础，这可能会提高拉合尔地区基本药物的可及性。与国际参考价格相比，拉合尔地区的药品价格较高。因此，必须努力制定有利于降价和提高可负担性的患者友好型药品定价政策。
