Price, availability and affordability of antineoplastic medicines in Harare’s public and private institutions: implications for access.
Mutyavaviri, Sly Ngoni.
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Background: Antineoplastic medicines are increasingly becoming more vital in many public health setups. There has been significant progress made in terms of newer molecules since the advent of chemotherapy. Despite the importance of antineoplastic medicines and advent of these molecules, there are still issues of limited availability and affordability in Zimbabwe. Currently the country has no government initiated policies on pricing and accessibility of antineoplastic medicines in public and private institutions, placing health care consumers at risk. A study was therefore designed to assess the price, availability and affordability of antineoplastic medicines in Harare Province, Zimbabwe. Methods: The study was based on the standardised method recommended by the World Health Organisation (WHO) and Health Action International (HAI). A data collection form-based cross-sectional survey was conducted in public and private medicine outlets. A total of 153 facilities were surveyed. The facilities consisted of three (3) public institutions and one hundred and fifty (150) private pharmacies in Harare and surrounding towns. The percentage availability, median price ratio using International Reference Prices, mark-ups, price and affordability of antineoplastic medicines were determined. Affordability was determined by using the wage of the lowest paid government worker which was USD296 per month. Median price ratios were calculated for twenty-two (22) of the antineoplastic medicines that were imported into the country from the import records at the Medicines Control Authority and also appearing on the medicines register for private pharmacies and seven (7) medicines for the public hospital pharmacies. The WHO’s International Reference Prices were used for calculation of median price ratios. Range, mode and average mark-up percentages for the antineoplastic medicines were also determined. Availability and price in the public sector was compared to availability in the private sector. Affordability was calculated as the out-of-pocket day’s wages to buy a monthly cycle of the antineoplastic medicine. Results: The percentage availability of the antineoplastic medicines at the government institutions was 25%, whilst the percentage availability of the antineoplastic medicines in the private sector ranged from 1% to 42.7%. Fifty percent of the twenty-two (22) medicines in the private sector had a median price ratio of lower than 4. The median price ratio in the private sector ranged from 0.60 to 11. Median price ratios were calculated for seven (7) medicines in the public sector. The median price ratio in the public sector ranged from 0.73 to 2.25. Eleven (11) of the medicines in the private sector were affordable with ten (10) days wage and below. Eight of the medicines were slightly affordable with wage days more than 10 days wage but less than 20 days wage. Wage days in private sector ranged from 1 day to 490 days. Affordability of the medicines in the public sector ranged from 1 to 10 days wage. Average percentage mark-up was 51.3% in the private sector and 34% in the public sector for the medicines that were available. Conclusion: Medicines were generally more available in the private sector than in the public sector. The government needs to continue supporting the National Pharmaceutical Company’s procurement of antineoplastic medicines. Generally medicines were more affordable in the public sector than in the private sector. The high percentage mark-ups calculated in the private sector compared to the public sector are as a result of the overhead expenses in private pharmacies which have to be borne from the actual sales of the medicines unlike in the public sector were the services are subsidised by the government. The low availability of antineoplastic medicines coupled with a very high unemployment rate means there is a huge burden on accessibility of antineoplastic medicines in Harare. Most patients cannot afford antineoplastic medicines which can result in increased mortality. There is a need to subsidise the medicines to improve accessibility. This will reduce the out-of-pocket expenses made by patients. There is a need to also ensure that medical insurance in Zimbabwe allow all pharmacies to retail antineoplastic medicines instead of the selective incorporation of pharmacies into their health insurance schemes. The calculated median price ratios range showed that the prices of the medicines are varied and there is need to have medicine procurement and pricing policies that minimise the median price ratio to lower than 5 for all antineoplastic medicines.