Comparing Medicine Prices Among Countries

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Comparing Medicine Prices Among Countries
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Why compare across countries?

• Principal investigators want to know how their
  results differ from other countries results
• WHO/HAI and external users want to
• describe world drug markets from consumer
  perspective
• inform global drug policy discussions
• examine variations in results in light of
  differences in local policy environments

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What can we compare?

• Single drug comparisons, e.g.
• MPR ratio of median price found to
  international reference price, in USD
• affordability days wages for std. tx.
• Summary statistics across many drugs in each
  country, e.g.
• median MPR for all innovators at retail
• interquartile range of MPRs

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Median Price Ratios for Nifedipine (Retail)
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Days Wages for Nifedipine Tx (Retail)
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Summary stats Retail MPR medians IQRs, ?
Innovator Brand Most Sold Generic
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Challenges of cross-country comparisons
Single-drug comparisons

• WHO/HAI core list of 30 drugs ?
• Opportunities for 1-drug comparisons
• However
• local epidemiological profiles differ
• local treatment approaches differ
• national registration patent status differ
• ? market share role for drug differ

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• Economic vagaries
• currency exchange rate, currency values
• purchasing power
• generosity of min. government wage
• Name-brand drugs
• source country of origin vary
• quality may vary?
• Lowest priced generics
• names not specified
• names vary within, between countries
• quality varies how much?

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Challenges of cross-country comparisons
Summary stats over many drugs

• Variations in lists of drugs surveyed
• core substance or strength not available
• local supplementary drugs
• To keep in mind
• multi-drug summary statistics are crude indices
  only
• nevertheless, orders of magnitude are probably
  meaningful

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Median Price Ratios for omeprazole
Most Sold Generic
Innovator Brand
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Days wages for omeprazole treatment
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Caveats for making cross-country comparisons

• Single-drug comparisons
• good validity
• but still not perfect
• Multi-drug comparisons
• less valid when lists differ
• matched drugs ? always more valid
• but matching drugs ? smaller sample (less
  reliable)

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Caveats for making cross-country comparisons

• Give typical values, not extremes
• Large differences more likely real than small
  differences
• Be as transparent as possible
• append details underlying analyses
• post drug names origins on HAI web
• Use cautious language
• Starting point only ? keep digging

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WHO/HAI survey in Rajasthan, IndiaWeb-based
pharmacies for US consumers, in US vs.
abroad(using LPG)
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8 Pilot Surveys India US websitesMedians
and IQRs of MPRs(Private For-Profit)
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Lowest Priced Generics Prices to PtsMedians
and IQRs of MPRs
Public Sector
Mission Sector
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Public Procurement Prices for GenericsMedians
and IQRs of MPRs
pub. teaching hosps buying on local private
market