1. August 27th 2008 1 Availability, Pricing and Affordability of Asthma Medicines 2001-2006 Presentation for Meeting on Availability, Pricing and Affordability of NCD Medicines WHO Geneva Ntabeko Mpanza Richard Laing

2. August 27th 2008 2 Outline Introduction & Background Methodology Results Availability Pricing Affordability Discussion & Policy options

3. August 27th 2008 3 Introduction & Bac k ground Asthma was the 25th leading cause of disability adjusted life years lost worldwide in 2001, estimated to be about 15 million DALYs per year Beclomethasone inhalers and salbutamol inhalers are on the WHO EML. Recent paper in Allergy by N. Ait-Khaled, D. A. Enarson, K. Bissell, N. E. Billo. Access to inhaled corticosteroids is key to improving quality of care for asthma in developing countries. However, many patients have difficulty accessing treatment; it is a challenge for them to get their medication and so, levels of uncontrolled asthma cases remain high. Aim: Secondary analysis of price, availability and affordability of CVD medicines in 36 developing countries that have undertaken WHO/HAI surveys

4. August 27th 2008 4 Methodology WHO/HAI data Standardized data collection Prices as Median Price Ratios (MPRs) Medicines: Salbutamol 0.1mg/dose 200 dose inhalant Beclomethasone 50ug/dose 200 dose inhalant Secondary analysis Adjustments for inflation and purchasing power Analysis by World Bank Income Groups and WHO regions.

5. August 27th 2008 5 Country list (48 surveys in 35 countries) Low income Chad Ethiopia (2004) 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-West Bengal Kenya (2004) Kyrgyzstan (2005) Mali (2004) Mongolia (2004) Nigeria (2004) Pakistan (2004) Sudan-Gadarif (2006) Sudan-Khartoum (2005) Sudan-Kordofan (2006) Tajikistan (2005) Tanzania (2004) Uganda (2004) Uzbekistan (2004) Yemen (2006) Lower-middle income Armenia (2001) Cameroon (2002) China-Shandong Province (2004) China-Shanghai (2006) El-Salvador (2006) Fiji (2004) Indonesia (2004) Jordan (2004) Morocco (2004) Peru (2005) Philippines (2005) Sri Lanka (2001) Syria (2003) Tunisia (2004) Upper-middle income Brazil-Rio de Janeiro (2001) Kazakhstan (2004) Lebanon (2004) Malaysia (2004) South Africa - Kwazulu Natal (2001) High Income Kuwait (2004) United Arab Emirates (2006)

6. August 27th 2008 6 Results: Availability (%) Overall Availability of Beclomethasone and Salbutamol– WB Income Group Classifications Note: The numbers next to the income categories represent the number of countries that were found in the WHO HAI website

7. August 27th 2008 7 Procurement and Patient Prices Adjusted for CPI and MSH prices

8. August 27th 2008 8 Median Price Ratios of Beclomethasone and Salbutamol with surveys divided into Income Group categories Adjusted for CPI, MSH prices and PPP

9. August 27th 2008 9 Affordability Days wages of Lowest Paid Government Worker Note: Average income often below lowest government wage Need for multiple medicines

10. August 27th 2008 10 Discussion & Policy options Availability Ensure availability of BOTH Beclo and salbutamol Increase public sector funding for Asthma medicines Procurement Some countries: can improve on procurement prices possibly through ADF Where procurement prices are good consider selling at cost to private sector or through patient associations Patient prices Lower taxes & tariffs Promote the use of generics Reduce mark-ups

11. August 27th 2008 11 Thank you Please send any comments to:mpanzm@yahoo.com & laingr@who.int laingr@who.int