Price surveys and component analysis

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Price surveys and component analysis
Measuring medicine prices, availability,
affordability and price components
World Health OrganizationHealth Action
International
Anita Kotwani Deptt of Pharmacology V.P.Chest
Institute University of Delhi India
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Survey tool

• Launched at the World Health Assembly in
  2003
• Measures
• patient prices
• public sector procurement prices
• availability
• treatment affordability
• price components in the supply chain
• About 50 surveys to date in all regions
• Monitoring tool in development

Data information on HAI website
www.haiweb.org/medicineprices
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Methodology

• Systematic sampling at least 6 regions, minimum
  of 5 pharmacies/facilities per sector per region
• Public sector facilities, private retail
  pharmacies and other sectors (e.g. dispensing
  doctors or mission sector)
• Prices of 30 pre-selected commonly used medicines
  14 global 16 regional
• Predetermined dose form strength, recommended
  pack size
• Supplementary medicines highly encouraged,
  adapted to local needs
• Prices of originator brand and lowest price
  generic are collected, referenced to
  international benchmark (MSH)
• Availability of medicine on day of survey
• Affordability - number of days wages for lowest
  paid unskilled government worker to purchase
  pre-selected courses of treatment
• All components of price from manufacturer to
  retailer identified

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Surveys to date

• Middle East Lebanon, Jordan, Kuwait, Syria,
  Sudan, UAE, Yemen
• Francophone Africa Tunisia, Morocco, Algeria,
  Mali, Chad, Senegal, Niger, Cameroon
• Anglophone Africa Uganda, South Africa,
  Tanzania, Kenya, Ethiopia, Zimbabwe, Nigeria,
  Ghana
• Asia/Pacific Mongolia, China Shandong
  Shanghai, Philippines, Malaysia, Pakistan, Fiji,
  Indonesia, Vietnam
• India West Bengal, Haryana, Karnataka,
  Maharashtra (2), Chennai, Rajasthan
• Central Asia Kazakhstan, Tajikistan, Kyrgyzstan,
  Uzbekistan
• Europe Bosnia Herzegovina, Kosovo
• South America Peru

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Designed to answer the following

• What price do people pay for essential medicines?
• Do the prices of these drugs vary in different
  sectors, e.g., public, private and other sector?
• Do the prices of medicines vary in different
  regions of a State/Country?
• What is the difference in prices of originator
  brands and generically equivalent medicines?
• How do the prices of medicines in the different
  sectors of the State compare to international
  reference price (IRP)?
• What is the availability of the medicines in
  different sectors?
• How affordable are medicines for ordinary people?
• What is the level of various mark-ups which
  contribute to their retail prices?

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Price component Stage model
IMPORTED
LOCALLY PRODUCED
MSP Frieght Insurance
MSP Local Transport
Allows to study the entire supply chain, a single
stage or an individual price component
STAGE 5 STAGE4 STAGE 3
STAGE 2 STAGE 1 DISPENSED COST
RETAIL WHOLESALE
LANDED COST CFT/
MSP

• Overhead Costs
• Rent
• Salaries
• Electricity
• Security

Warehouse markup, Government Store Charges
Local Transport
.
Allows inter-sectoral and inter-country
comparisons
OR
Retail Markup
Health center charges

• Dispensing Fee
• Sales Tax
• VAT

.
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Medicine Price Components

• Pricing structure of the country
• Price components along entire supply chain
• Both public and private sector
• Both scheduled and non scheduled medicines
• Both on-patent and off-patent medicines
• Medicines with price variation and little
  variation
• Survey conducted in Delhi Feb-March07

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Supply chain and Sampling

• Medicines are categorized as branded and
  branded generics
• If the manufacturer does the marketing (branded),
  the medicines move from the manufacturer
  CF agent(2-4) wholesalers(8 or 10),
  retail shops (16 or20)
• If the manufacturer does not do the marketing
  (branded generic), medicines pass through
  a super-stockist (super wholesaler)/ wholesaler
  distributes medicines directly to retailers
• Private sector - Data was collected from 3
  manufacturers, 1 superstockist/wholesaler, 4
  wholesalers and 7 retailers in urban and
  peri-urban areas of NCT Delhi
• Public sector Data was collected from 4 major
  government health providers to population of NCT
  Delhi

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Medicines selection
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Unit prices paid in all 4 public providers
(Prices in Rupees)
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Ciprofloxacin price components
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Examples of trade schemes
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Conclusion

• Medicine Prices a new approach to measurement
  is a robust methodology
• Medicine price survey (WHO-HAI methodology) -
  Tool to measure medicine prices, availability,
  affordability and price component in different
  sectors of a region/country
• Comparison between different surveys can easily
  be done