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Too Costly & Too Scarce

Ewen, M.A.

2016

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citation for published version (APA)

Ewen, M. A. (2016). Too Costly & Too Scarce: Price, availability and affordability of medicines in low- and

middle-income countries.

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^ƵŵŵĂƌLJ

DĞĚŝĐŝŶĞ ƉƌŝĐĞ ŵĂƩĞƌƐ͘ dŚĞLJ ŵĂƩĞƌ ƚŽ ŐŽǀĞƌŶŵĞŶƚƐ ǁŝƚŚ ůŝŵŝƚĞĚ ƉŚĂƌŵĂĐĞƵƟĐĂů ďƵĚŐĞƚƐ͘dŚĞLJŵĂƩĞƌƚŽƉĂƟĞŶƚƐ͕ĞƐƉĞĐŝĂůůLJƚŚŽƐĞǁŚŽŚĂǀĞƚŽƉĂLJĨŽƌŵĞĚŝĐŝŶĞƐŽƵƚͲŽĨͲ ƉŽĐŬĞƚ͕ŝŶĐůƵĚŝŶŐƵƉƚŽϵϬйŽĨƚŚĞƉŽƉƵůĂƟŽŶŝŶŵĂŶLJ>D/Ɛ͘DĞĚŝĐŝŶĞĂǀĂŝůĂďŝůŝƚLJĂůƐŽ ŵĂƩĞƌƐ͘/ƚŵĂƩĞƌƐĞƐƉĞĐŝĂůůLJƚŽƚŚĞƉŽŽƌǁŚŽƌĞůLJŽŶĂĐĐĞƐƐŝŶŐƚŚĞŵĞĚŝĐŝŶĞƐƚŚĞLJŶĞĞĚ ŝŶƉƵďůŝĐŚĞĂůƚŚĐĂƌĞĨĂĐŝůŝƟĞƐ͕ĞŝƚŚĞƌĨƌĞĞͲŽĨͲĐŚĂƌŐĞŽƌĂƚĂīŽƌĚĂďůĞƉƌŝĐĞƐ͘>ŽǁŵĞĚŝĐŝŶĞ availability in the public sector forces people to purchase medicines in the private sector, usually at far higher prices.

ϭϲϲ WƌŝŽƌƚŽϮϬϬϭ͕ůŝƩůĞǁĂƐŬŶŽǁŶĂďŽƵƚŵĞĚŝĐŝŶĞƉƌŝĐĞƐĂŶĚĂǀĂŝůĂďŝůŝƚLJŝŶ>D/Ɛ͘dŚŝƐƚŚĞƐŝƐ ĚĞƐĐƌŝďĞƐƚŚĞǁŽƌŬƵŶĚĞƌƚĂŬĞŶƐŝŶĐĞƚŚĞŶƚŽĚĞǀĞůŽƉƚŚĞt,Kͬ,/ƐƵƌǀĞLJƚŽŽůƐ͕ŵĞĂƐƵƌĞ ŵĞĚŝĐŝŶĞ ƉƌŝĐĞƐ͕ ĂǀĂŝůĂďŝůŝƚLJ͕ ĂīŽƌĚĂďŝůŝƚLJ͕ ĂŶĚ ƉƌŝĐĞ ĐŽŵƉŽŶĞŶƚƐ͕ ĂŶĚ ŝĚĞŶƟĨLJ ƉŽůŝĐLJ ŽƉƟŽŶƐ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ƐŝƚƵĂƟŽŶ͘ DƵůƟƉůĞ ĂŶĚ ŽŌĞŶ ŝŶƚĞƌůŝŶŬĞĚ ĨĂĐƚŽƌƐ ĐĂŶ ŝŶŇƵĞŶĐĞ ŵĞĚŝĐŝŶĞ ĂǀĂŝůĂďŝůŝƚLJ ĂŶĚ ĂīŽƌĚĂďŝůŝƚLJ͕ ŚĞŶĐĞ ƚŚĞ ŝŵƉĂĐƚ ŽĨ ƐŽŵĞ ĨĂĐƚŽƌƐ ŽŶ ĂǀĂŝůĂďŝůŝƚLJ and prices is assessed.

,LJƉŽƚŚĞƐĞƐ ^ŝdž ŚLJƉŽƚŚĞƐĞƐ ĂƌĞ ƉƌŽƉŽƐĞĚ ŝŶ ƚŚŝƐ ƚŚĞƐŝƐ ;ϭͿ DĞĚŝĐŝŶĞ ĂǀĂŝůĂďŝůŝƚLJ ŝƐ ƐƵďŽƉƟŵĂů ĂŶĚ ĂīŽƌĚĂďŝůŝƚLJ ŝƐ ƉŽŽƌ ŝŶ >D/Ɛ͕ ĂŶĚ ĂǀĂŝůĂďŝůŝƚLJ ĂŶĚ ĂīŽƌĚĂďŝůŝƚLJ ĐĂŶŶŽƚ ďĞ ĐŽŶƐŝĚĞƌĞĚ ŝŶ ŝƐŽůĂƟŽŶ͖ ;ϮͿ ĂƌƌŝĞƌƐ Ăƚ ǀĂƌŝŽƵƐ ůĞǀĞůƐ ŝŵƉĂĐƚ ŵĞĚŝĐŝŶĞ ĂǀĂŝůĂďŝůŝƚLJ͕ ƉƌŝĐĞƐ͕ ĂŶĚ ĂīŽƌĚĂďŝůŝƚLJ͖ ;ϯͿ 'ŽǀĞƌŶŵĞŶƚƐ ŝŶ >D/Ɛ ĂƌĞ ƉƌŽĐƵƌŝŶŐ ŵĞĚŝĐŝŶĞƐ Ăƚ ƉƌŝĐĞƐ ĨĂƌ ĂďŽǀĞ ŝŶƚĞƌŶĂƟŽŶĂůƌĞĨĞƌĞŶĐĞƉƌŝĐĞƐ͖;ϰͿD>ƐŚĂǀĞĂƉŽƐŝƟǀĞĞīĞĐƚŽŶĂǀĂŝůĂďŝůŝƚLJ͖;ϱͿŶĂůLJƐŝŶŐ ƉƌŽĐƵƌĞŵĞŶƚƉƌŝĐĞƐĐĂŶůĞĂĚƚŽƉŽƐŝƟǀĞŽƵƚĐŽŵĞƐĨŽƌƚŚĞƉƌŽĐƵƌĞŵĞŶƚƉƌŽĐĞƐƐ͖ĂŶĚ;ϲͿ >ŽĐĂůƉƌŽĚƵĐƟŽŶƌĞƐƵůƚƐŝŶůŽǁĞƌƉƌŝĐĞƐĂŶĚŝŵƉƌŽǀĞĚĂǀĂŝůĂďŝůŝƚLJ͘ ZĞƐĞĂƌĐŚƋƵĞƐƟŽŶƐ dŽĚĞƚĞƌŵŝŶĞǁŚĞƚŚĞƌƚŚĞƐĞŚLJƉŽƚŚĞƐĞƐĂƌĞƐƵƉƉŽƌƚĞĚŽƌŶŽƚ͕ƚŚĞƚŚĞƐŝƐǁĂƐĚĞƐŝŐŶĞĚƚŽ ĂŶƐǁĞƌƚŚĞĨŽůůŽǁŝŶŐƌĞƐĞĂƌĐŚƋƵĞƐƟŽŶ͗tŚĂƚŝƐƚŚĞƉƌŝĐĞ͕ĂǀĂŝůĂďŝůŝƚLJ͕ĂīŽƌĚĂďŝůŝƚLJ͕ĂŶĚ

price components of commonly used medicines in LMICs and what are some of the factors inŇuencinŐ prices and aǀailaďility͍

dŽĂŶƐǁĞƌƚŚŝƐƋƵĞƐƟŽŶ͕ƚǁŽƐƵďͲƋƵĞƐƟŽŶƐŚĂǀĞďĞĞŶĨŽƌŵƵůĂƚĞĚ͗

(1) In LMICs͕ what is the aǀailaďility͕ price͕ aīordaďility͕ and price components of medicines used to treat communicaďle diseases and ECs͍

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(Ϯ) In LMICs͕ what is the inŇuence of the followinŐ factors on aǀailaďility andͬor prices͗ (a) Inclusion of medicines in naƟonal MLs͍

(b) Wublic sector procurement and price transparency͍ (c) Local medicine producƟon͍

dŚĞƐĞƋƵĞƐƟŽŶƐĂƐŬĂďŽƵƚƚŚĞŝŶŇƵĞŶĐĞŽĨƚŚƌĞĞƐƉĞĐŝĮĐĨĂĐƚŽƌƐŽŶŵĞĚŝĐŝŶĞĂǀĂŝůĂďŝůŝƚLJ ĂŶĚͬŽƌ ƉƌŝĐĞƐ͘ dŚĞ ĮƌƐƚ ƋƵĞƐƟŽŶ ĨŽĐƵƐĞƐ ƐŽůĞůLJ ŽŶ ŵĞĚŝĐŝŶĞ ĂǀĂŝůĂďŝůŝƚLJ͕ ĂŶĚ ĂƐŬƐ ǁŚĞƚŚĞƌŝŶĐůƵƐŝŽŶŝŶĂŶĂƟŽŶĂůD>ƌĞƐƵůƚƐŝŶŐƌĞĂƚĞƌĂǀĂŝůĂďŝůŝƚLJŝŶŽƵƚůĞƚƐ͘dŚĞƐĞĐŽŶĚ ƋƵĞƐƟŽŶĨŽĐƵƐĞƐŽŶƉƵďůŝĐƐĞĐƚŽƌƉƌŽĐƵƌĞŵĞŶƚŽĨŵĞĚŝĐŝŶĞƐ͕ĂŶĚƚŚĞŝŶŇƵĞŶĐĞŽĨƉƌŝĐĞ ƚƌĂŶƐƉĂƌĞŶĐLJĂŶĚĐŽŵƉĂƌŝŶŐƉƌŝĐĞƐƉĂŝĚďLJŽƚŚĞƌƉƵƌĐŚĂƐĞƌƐ͕ƚŽŝĚĞŶƟĨLJƉŽƚĞŶƟĂůƐĂǀŝŶŐƐ͘ dŚĞĮŶĂůƋƵĞƐƟŽŶĂƐŬƐŝĨůŽĐĂůŵĞĚŝĐŝŶĞƉƌŽĚƵĐƟŽŶŝŶŇƵĞŶĐĞƐƚŚĞĂǀĂŝůĂďŝůŝƚLJĂŶĚƉƌŝĐĞƐ of medicines in outlets in the manufacturing country.