Siddharthan, Trishul; Robertson, Nicole M; Rykiel, Natalie A; Underhill, Lindsay J; Rahman, Nihaal; Kafle, Sujan; Mohan, Sakshi; ... Pollard, Suzanne L; + view all Siddharthan, Trishul; Robertson, Nicole M; Rykiel, Natalie A; Underhill, Lindsay J; Rahman, Nihaal; Kafle, Sujan; Mohan, Sakshi; Padalkar, Roma; McKeown, Sarah; Flores-Flores, Oscar; Quaderi, Shumonta A; Alupo, Patricia; Kalyesubula, Robert; Kirenga, Bruce; Luo, Jing; Cárdenas, Maria Kathia; Gianella, Gonzalo; Miranda, J Jaime; Checkley, William; Hurst, John R; Pollard, Suzanne L; - view fewer (2022) Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings. PLoS Global Public Health , 2 (12) , Article e0001309. 10.1371/journal.pgph.0001309.

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Abstract

INTRODUCTION: Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). METHODS: All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD. RESULTS: We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. CONCLUSION: The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.

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