Survey of medicine prices, availability and affordability in Mandalay, Myanmar

Abstract

A cross-sectional study was conducted in 6 townships of Mandalay, Myanmar, in March, 2012. The main purposes of this study were to identify the price, availability and affordability of selected medicines. Methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 30 medicines were collected from 20 dispensing doctors (DD), 10 drug stores in public hospitals (PH), 30 drug stores in private hospitals (PP), 30 private sector retail pharmacies, and 3 private wholesale pharmacies in Mandalay District. Medicine prices were compared with international reference prices (IRPs) to obtain medicine price ratios (MPRs). The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. In all sectors, prices of both lowest and highest priced generics were lower than the price of originator brand name products. Availability of the originator brand was extremely low (<4%). Overall, availability of the generics was moderate (50-66%). MPR of the originator brand ranged from 2.9 for salbutamol in private wholesale to 55.1 in drug stores in private hospital for atorvastatin. Median MPR of the highest priced generic ranged from 3.2 in private wholesale and 7.5 in private retail to 9.5 in DDs. Median MPR of the lowest priced generic ranged from 1.6 and 2.0 in the private wholesale and private retail respectively to 3.1 in DD. Lowest price and highest priced were differed with greater variations. Overall, highest priced generic was 2.5 times and 3.5-4times more expensive than lowest priced generic in private wholesale and other sectors respectively. People can afford lowest priced generic more than the highest priced generic in all the sectors. Two-way analysis of variance showed that mean absolute and proportional price differences between lowest and highest priced generics did not differ statistically significantly by sector, but did differ by drug class (p=0.004 and p<0.001, respectively). Sector-class interactions were also significant (p<0.001 and p=0.044, respectively). Absolute differences were highest for antibiotics, and proportional differences were lowest for respiratory medicines.