Asthma medicines still unaffordable for many

Globally around 300 million people suffer from asthma, yet for many of them living in low- and middle-income countries access to quality-assured, affordable asthma essential medicines still remains a distant dream. This was revealed in a study conducted by Dr Zaheer Babar from the School of Pharmacy at the University of Auckland and Dr Karen Bissell from the University’s School of Population Health and International Union Against Tuberculosis and Lung Disease (The Union), and published in the journal PharmacoEconomics.

The study investigated the availability, pricing and affordability of the three main asthma medicines (beclometasone, budesonide and salbutamol) which are on the World Health Organisation’s (WHO’s) Model List of Essential Medicines - in 52 selected low- and middle-income countries. It found that essential asthma medicines are still largely unavailable and unaffordable for most in low-income countries.

"The provision of affordable essential medicines is one of the United Nations Millennium Development Goals, but there are millions of people suffering from asthma in low and middle income countries who cannot access the essential asthma medicines recommended by the WHO. The medicines are either not available, or if they are available, they are so expensive that people cannot afford to buy them," said Dr Babar.

The study used as benchmarks the international reference prices (IRPs) generated by Management Sciences for Health, and the 2011 prices of the Asthma Drug Facility (ADF), which were lower than the IRPs. Data collected as part of the study from private retail pharmacies, national procurement centres and public hospitals found a considerable variability in pricing and affordability across countries. Availability for inhaled corticosteroids was particularly poor, and worse in national procurement centres and main hospitals. Many national Essential Medicines Lists (EMLs) had not been updated to incorporate inhaled corticosteroids.

According to Dr Bissell, "Poor availability of inhaled corticosteroids is a serious matter, because under-use of inhaled corticosteroids results in poor asthma control, frequent unplanned visits to the emergency room, more hospitalisations and an unnecessary reduction in quality of life for those who live with asthma."

Then again, the surveyed strength of beclometasone was on the EML of only 10 of the surveyed countries. Procurement systems appeared largely inefficient when ADF prices were applied as references. Some countries seemed to be subsidising asthma medicines, making them free or less expensive for patients, while others were applying very high margins, which can significantly increase the price for patients unless a reimbursement system exists.

Procurement of generic medicines is generally expected to result in cost saving and improved affordability. In the majority of cases the prices for innovator brand medicines were found to be higher than for the generic medicines. But in India and Kenya the price of innovator brand salbutamol in private retail pharmacies was less than the generic medicine.

The study’s findings raise important policy concerns-- availability of inhaled corticosteroids is poor; many EMLs are not updated; IRPs can be misleading; health systems and patients are paying more than necessary for asthma medicines, which are unaffordable for many patients in many countries. Professor Innes Asher, Chair of the Global Asthma Network, lamented that, "This study proves that people in low- and middle-income countries are not benefiting from the essential asthma medicines they need, to control their asthma and lead active, productive lives. International and national efforts to address Non Communicable Diseases (NCDs) will be futile unless we urgently address issues of availability, affordability and quality of the essential medicines and technologies required to treat and manage NCDs such as asthma".

The Global Asthma Network has rightly called for action from the global NCD movement for asthma to be properly recognised as a major chronic NCD, and for global NCD policy, strategy and funding to give due priority to resolving problems of access to essential medicines for asthma and other major NCDs. Professor Asher will also be giving a plenary lecture on 'Asthma: the forgotten epidemic?' at the forthcoming 44th Union World Conference on Lung Health in Paris, to connect the dots and focus attention around  this debilitating yet often neglected disease.

Shobha Shukla, Citizen News Service - CNS
October 2013

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