Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis

摘要: Summary Background WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, price components in low-income middle-income countries. Here, we present secondary analysis of availability 45 national subnational surveys done using the WHO/HAI methodology. Methods Data from 36 countries were adjusted inflation or deflation purchasing power parity. reference prices open international procurements generic products used as comparators. Results are presented 15 medicines included at least 80% four individual medicines. Findings Average public sector ranged 29·4% to 54·4% across regions. Median government procurement 1·11 times corresponding although efficiency 0·09 5·37 prices. Low did not always translate into low patient Private patients paid 9–25 lowest-priced over 20 originator Treatments acute chronic illness largely unaffordable many In private sector, wholesale mark-ups 2% 380%, whereas retail 10% 552%. where value added tax was applied medicines, amount charged varied 4% 15%. Interpretation Overall, substantially higher than would be expected if distribution efficient reasonable. Policy options such promoting alternative financing mechanisms needed increase reduce improve affordability. Funding None.