Medicine pricing: Impact on accessibility and affordability of medicines vis a vis the product origin as pharmaco-economic drivers in Comoros

Abstract

This paper highlights the availability, pricing and affordability of popular medicines in Comoros. We used the standardized survey methodology developed by the World Health Organization and Health Action International to conduct a cross sectional survey for collecting data on availability and patient prices of medicines in public, private and mission sector medicines outlets from April 1 to June 30, 2014. Median availability of medicines in Comoros across all sectors was particularly low at 31.11% for all product types. The median price ratios of procurement prices for original brands, most sold generics and lowest-priced generics in the public sector, were 11.60, 4.74 and 3, respectively. These were 83 times higher than the international reference prices; and the median price ratios of retail prices to patients for lowest priced generics in the private sector were 29.49% higher than those in the public sector. For most of the population, the medicine prices are unaffordable particularly in the islands Ndzuwani and Mwali, where many people earn less 1$ per day. The survey revealed higher procurement prices and poor availability in the public sector. Various policy adjustments could increase the availability of essential medicines and reduce their prices for the low income population.

A desktop review of evaluation of implementation of national medicines policies in SADC countries

“…Therefore, there is a need for countries to develop pricing policies and monitor their pharmaceutical expenditure. Although a correlation between pharmaceutical expenditure and total health expenditure is poorly understood, WHO/HAI pricing surveys have been used to determine the extent of price differentiation and affordability in countries studies carried out in Comoros, Eswatini, South Africa and the Republic of Tanzania revealed the need to increase affordability of medicines and high median pricing ratios (MPR) that are higher than international reference prices [ [29] , [51] , [52] , [53] ]. This evidence, though rudimentary can inform policymakers and stakeholders in SADC countries to urgently address their domestic policies on pricing and pharmaceutical expenditure since they may improve the availability, affordability and accessibility of medicines thus eradicating disease burdens and promoting the well-being of populations.…”

“…These impact studies by Bangalee & Suleman [ 57 ], Wouters et al [ 58 ], Moodley & Suleman [ 59 ], Perumal-Pillay [ 60 ] revealed the extent to which positive price regulation effects have generated smaller price increments in the price setting of medicines thus improving the affordability of medicines. Interestingly, a pharmacoeconomic impact study in the Comoros by Kassim, Alolga & Assanhou et al [ 51 ], revealed higher procurement prices resulting in poor availability of medicines in the public sector. Therefore, pricing studies are a requisite for developing countries to understand their economic situation and how to best allocate resources in maximising access to medicines thus reducing financial inequities in communities.…”