Oldfield Lachlan, Penm Jonathan, Mirzaei Ardalan, Moles Rebekah
School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Pharmacy, Prince of Wales Hospital, Sydney, NSW, Australia.
Lancet Glob Health. 2025 Jan;13(1):e50-e58. doi: 10.1016/S2214-109X(24)00442-X.
Medication shortages are a pressing concern throughout the world. To gain insight into this issue, WHO and Health Action International (HAI) have constructed a validated method to survey medicine prices, availability, and affordability in low-income and middle-income countries. This paper aims to present an updated analysis of medicine affordability, availability, and pricing across 54 countries using the WHO-HAI method, highlighting disparities between public and private sectors.
A search was conducted using the HAI Essential Medicines Access Database and four electronic databases to locate studies using the WHO-HAI method. A total of 71 surveys were included, spanning 54 countries. Data concerned with availability, affordability, and pricing were extracted and synthesised. Availability was defined as the average percentage of outlets stocking a medicine on the survey day; affordability was defined as the days' wages of the lowest-paid unskilled government worker required for a standard treatment; and prices were defined as the medicine's median price relative to the Management Sciences for Health international reference median price. Results are presented for the 15 most reported medicines that were included in at least 75% of surveys. Results are also presented for four commonly used medicines selected to facilitate comparison with previous secondary analyses.
The average availability of generic medicines across WHO regions ranged from 37·8% to 68·3% in the public sector and from 42·3% to 77·4% in the private sector. The availability of originator brand medicines in the private sector ranged from 18·0% to 47·6% across these regions. Neither the public nor the private sector in any region met WHO's recommended availability target of 80%. Medicine prices were consistently high across all WHO regions, requiring patients to pay 3·0-11·5 times international reference prices for lowest-priced generic medicines and over 25 times international reference prices for originator products across WHO regions. Treatment of both acute and chronic illnesses remained unaffordable in many regions, requiring patients to pay 0·2-37·0 days' wages to purchase a single course of medicine.
Access to essential medicines remains a global challenge. Medicines consistently display high prices, low affordability, and poor availability. Although there have been some advancements, the overall accessibility of essential medicines remains a substantial global concern. Innovative and targeted strategies are essential to enhance access, requiring a concerted effort from governments, health-care organisations, and international bodies to implement solutions that address both economic and logistical barriers.
None.
药品短缺是全球范围内的一个紧迫问题。为深入了解这一问题，世界卫生组织（WHO）和国际卫生行动组织（HAI）构建了一种经过验证的方法，用于调查低收入和中等收入国家的药品价格、可及性和可负担性。本文旨在使用WHO-HAI方法对54个国家的药品可负担性、可及性和定价进行更新分析，突出公共部门和私营部门之间的差异。
利用HAI基本药物获取数据库和四个电子数据库进行检索，以查找使用WHO-HAI方法的研究。共纳入了71项调查，涉及54个国家。提取并综合了与可及性、可负担性和定价相关的数据。可及性定义为调查当天有药品库存的销售点的平均百分比；可负担性定义为标准治疗所需的最低工资非技术政府工作人员的日工资；价格定义为相对于健康管理科学国际参考中位价格的药品中位价格。给出了至少75%的调查中包含的15种报告最多的药品的结果。还给出了为便于与之前的二次分析进行比较而选择的四种常用药品的结果。
WHO各区域通用药品在公共部门的平均可及性范围为37.8%至68.3%，在私营部门为42.3%至77.4%。这些区域私营部门中专利品牌药品的可及性范围为18.0%至47.6%。任何区域的公共部门和私营部门均未达到WHO建议的80%的可及性目标。WHO所有区域的药品价格一直居高不下，患者购买最低价格通用药品需支付国际参考价格的3.0至11.5倍，购买专利产品需支付国际参考价格的25倍以上。在许多地区，急性和慢性疾病的治疗费用仍然难以承受，患者购买一个疗程的药品需支付0.2至37.0天的工资。
获取基本药物仍然是一项全球挑战。药品一直呈现出高价格、低可负担性和差可及性的特点。尽管已经取得了一些进展，但基本药物的总体可及性仍然是一个重大的全球问题。创新和有针对性的策略对于提高可及性至关重要，这需要政府、医疗保健组织和国际机构共同努力，实施解决经济和物流障碍的方案。
无。
