Date post: | 27-Mar-2015 |
Category: |
Documents |
Upload: | amia-sinclair |
View: | 214 times |
Download: | 0 times |
Direct costs and availability of diabetes medicines in low-income and middle-income countries
Birgit Volman
27/08/2008
Meeting on Access to Medicines for Noncommunicable Chronic Diseases
World Health Organization, Geneva
2
Introduction
Methodology WHO/HAI
Follow-up ‘Price, availability and affordability – an international comparison of chronic diseases’ By Gelders S et al. (2006)
Consultative meeting 19/20 February
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
3
Background
Diabetes management: to control blood glucose concentration and to limit the chance for complications
Essential medicines: Metformin, Glibenclamide and Insulin
Monitoring equipments and syringes Literature study: - Medicine costs largest part- Treatment costs type 1 higher than type 2
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
4
Methodology
Objective: characterize costs and availability of diabetes medicines by country, WHO region and World Bank income group
Primary data- International Diabetes Federation (IDF)- International Insulin Foundation (IIF)- World Integrated Trade Solution database (WITS)- World Health Organization & Health Action International
(WHO/HAI)- IMS-Health
Secondary analysis: Prices adjusted for CPI and PPP
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
5
International Diabetes Federation
Four global surveys to identify barriers for accessing insulin and diabetes supplies
Methodology- 35 participating countries- Questionnaire
Results- Insulin was expensive and not available in rural
areas- Costs of diabetes treatment varied between
countries
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
6
International Insulin Foundation (I)
Rapid Assessment Protocol for Insulin Access (RAPIA)
Mali, Mozambique, Zambia and Nicaragua
Results:- Low availability Quantities were
estimated on past consumptions & poor communication
- Low mark-ups - High patient prices of insulin- High travel costs
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
7
International Insulin Foundation (II)
Differences in the procurement and patient price of insulin in the public and private sector
28,6%
-80,0%-73,5%
34,3%
14,8%
40,0%33,3%
-100%
-80%
-60%
-40%
-20%
0%
20%
40%
60%
M ali (2004) M ozambique (2003) Zambia (2003) Nicaragua (2007)
Surveyed countries
P ublic sector
P rivate sector
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
8
International Insulin Foundation (III)
32,02
5,88 4,19
36,26
53,09
38,12
63,32
0
10
20
30
40
50
60
70
Mali (2004) Mozambique (2003) Zambia (2003) Nicaragua (2007)
Pric
e in
ID
Patient prices of insulin in different sectors. Prices adjusted for CPI and PPP.
Public sector
Private sector
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
9
WITS database (I)
Import tariffs: custom duties set by the government of the importing country
- Provide little revenue- Influence the price for the patient- Not effectively used to protect local
industry
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
10
WITS database (II)
Import tariffs charged on finished products containing insulin.
Tariffs rate (%)
Number of countries
Low-income countries
Lower-middle-income countries
Upper-middle-income countries
High-income countries
0 92 (70%) 20 19 25 27
0-5 22 (17%) 6 13 3 0
5.1-10 11 (8%) 3 4 1 3***
10.1-20 6* (5%) 1 2 3 0
>20 1** (1%) 0 1 0 0
Total 132 30 39 32 30
* Countries with a 10.1-20% tariffs were Brazil, Uruguay, Argentina, Tunisia, Peru, India** Islamic Republic Iran (52%)*** Republic Korea, Austria and Israel
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
11
WITS database (III)
Comparison of the charged tariffs on insulin products between the year 2005 and 2008
Tariff range Year 2005 Year 2008
0% 75 92
0-5% 25 22
5.1-10% 17 11
10.1-20% 6 6
>20% 3 1
Total 126 132
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
12
World Health Organization/ Health Action International (I)
Data from 47 surveys
Results:- Wide variety between countries- Good procurement prices- High mark-ups (public sector)- Availability better in the private
sector than in the public sector
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
13
World Health Organization/ Health Action International (III)
Differences between the procurement and patient price in the public sector for the LPG of glibenclamide 5 mg
248%
170%
234%
6%
90%
153%
5%
26%
311%
21%
22%
0% 50% 100% 150% 200% 250% 300% 350%
Chad (2004)
Ethiopia (2004)
Ghana (2004)
Nigeria (2004)
Sudan-Gadarif (2006)
Sudan-Kordofan (2006)
Tanzania (2004)
Indonesia (2004)
J ordan (2004)
P eru (2005)
Kazakhstan (2004)
Differences in percentage
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
14
World Health Organization/ Health Action International (IV)
Brand premiums (glibenclamide 5 mg) in the private sector
11,515,00
9,001,16
1,010,890,880,871,031,03
5,002,56
1,851,64
5,93
6,0113,84
2,082,38
2,050,88
2,004,03
1,354,88
5,50
1,092,04
0,00 2,00 4,00 6,00 8,00 10,00 12,00 14,00 16,00
Ethiopia (2004)Ghana (2002)Ghana (2004)
India-Chennai (2004)
India-Haryana (2004)India-Karnataka (2004)
India-Maharashtra 12 districts (2004)India-Maharashtra 4 regions (2005)
India-Rajasthan (2003)
India-W est Bengal (2004)Kenya (2004)
Mali (2004)Nigeria (2004)
Pakistan (2004)Yemen (2006)
Fiji (2004)Indonesia (2004)
Jordan (2004)Morocco (2004)
Peru (2002)Philippines (2002)
Philippines (2005)Tunisia (2004)
Kazakhstan (2004)Lebanon (2004)
Malaysia (2004)
Kuw ait (2004)United Arab Emirates (2006)
LI
LM
IU
MI
HI
Co
un
trie
s p
er
inco
me
gro
up
Brand premium
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
15
World Health Organization/ Health Action International (VI)
Availability of the LPG of glibenclamide 5 mg and metformin 500 mg in the private and public sector of 33 countries
28%
19%
28%
53%
49%
56%
63%
33%
56%
68%
61%
69%
0% 10% 20% 30% 40% 50% 60% 70% 80%
LI countries
LM I countries
A ll countries
Availability in percentage
P rivate sector
P rivate sector
P ublic sector
P ublic sector
Glibenclamide
Glibenclamide
M etformin
M etformin
Glibenclamide
Glibenclamide
Glibenclamide
Glibenclamide
M etformin
M etformin
M etformin
M etformin
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
16
World Health Organization/ Health Action International (VII)
Affordability of one months therapy with the LP G of glibenclamide (5 mg, 2 times a day) and the LP G of metformin (500 mg, 3 times a day) in the private sector
0 1 2 3 4 5 6 7 8 9
Ethiopia (2004)Ghana (2004)
India-Chennai (2004)India-Haryana (2004)
India-Karnataka (2004)India-M aharashtra 12 districts (2004)India-M aharashtra 4 regions (2005)
India-Rajasthan (2003) India-West Bengal (2004)
Kenya (2004)M ongolia (2004)
Nigeria (2004)P akistan (2004)Tanzania (2004)
Sudan-Gadarif (2006)Sudan-Khartoum (2005)Sudan-Kordofan (2006)
Uganda (2004)Yemen (2006)
F iji (2004)Indonesia (2004)
J ordan (2004)M orocco (2004)
P eru (2005)P hilippines (2005)
Syria (2003)
Lebanon (2004)M alaysia (2004)
Kuwait (2004)United Arab Emirates (2006)
Affordability in days wages
M etformin500 mg
Glibenclamide5 mg
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
17
IMS-Health (I)*
49 low-income and middle-income countries
2000, 2005, 2006 and 2007 Defined Daily Dose
Results:- Increased consumption of metformin- Decreased consumption of glibenclamide- Increased total consumption of oral
hypoglycemic agents and insulin in low-income and middle-income countries
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
18
IMS-Health (II)*
Trend of oral hypoglycaemic agent consumption in 49 low-income and middle-income countries (% growth by year)
0
500
1000
1500
2000
2500
2000 2005 2006 2007Year
M ETFORM IN (38.3%)
GLIM EPIRIDE (128.3%)
GLIBENCLAM IDE (-2.8%)
GLICLAZIDE (4.2%)
GLIPIZIDE
PIOGLITAZONE
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
19
IMS-Health (III)*
Annual increase rates of oral hypoglycaemic agents and insulin by income group
GNI-group Annual increase rate (overall for 6 years from 2000 to 2007)
Oral hypoglycemic agents Insulin
Low-income countries 16.6% 12.7%
Lower-middle-income countries
13.8% 36.0%
Upper-middle-income countries
15.4% 15.9%
Total 15.5% 21.3%
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
20
Discussion/Conclusion
Objective: characterize costs and availability of diabetes medicines by country, WHO region and World Bank income group
- Variety per country- Availability: Poor communication, estimations
based on past consumption. Availability better in the private sector than in the public sector.
- Price: Taxes & tariffs. Low procurement price of metformin and glibenclamide, high procurement price of insulin. Large differences between the procurement price and patient price.
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
21
Recommendations
Governments should be aware of the low availability and large differences
Reasons for the large differences should be investigated
Differential pricing initiatives should be promoted Procurement in the public sector should be funded Competition should be stimulated Quality assured generics should be promoted Price and availability reporting mechanism should
be available at each WHO-region More detailed information per country is needed
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases
22
Questions?
27/08/2008Meeting on Access to Medicines for
Noncommunicable Chronic Diseases