Robertson N, et al. Quality of Care, Health Disparities and Healthcare Utilization Among Patients with Asthma or COPD. Presented at: American Thoracic Society International Conference; May 13-18, 2022; San Francisco (hybrid meeting).
Robertson reports no relevant financial disclosures.
SAN FRANCISCO — The availability and pricing of asthma and COPD medications varies across different settings, with greater availability in urban and higher-income settings compared with rural and lower-income settings, researchers reported.
“The burden of chronic respiratory disease is increasing globally, with the highest disease-related morbidity and mortality centered in ... low- and middle-income countries,” Nicole Robertson, MPH, from the University of Kentucky College of Medicine, said during a presentation at the American Thoracic Society International Conference. “Therefore, the World Health Organization has established an essential medication list, which includes numerous chronic respiratory medications and considers these medications a minimum medicinal need for a basic health care system.”
Researchers conducted a cross-sectional survey of 63 pharmacies in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private) from 2017 to 2019. Researchers collected availability and pricing data for COPD and asthma medications and determined the affordability based on a ratio of 1-month cost of a standard treatment regimen to the daily wage of the lowest paid government worker.
The WHO essential medication salbutamol was the most commonly used respiratory medication in all settings (95.2% in Nepal, 85.7% in Peru, 79.2% in Uganda). Ipratropium bromide inhalers were not available in Uganda. Beclomethasone and fluticasone were largely unavailable in Peru (33.7% and 5.8%, respectively) and Nepal (30% and 6.1%, respectively) and were unavailable in Uganda. Salmeterol was only available in 30.3% of pharmacies in Nepal, most of which were public (66.6%). Tiotropium monotherapy was also only available in 77.8% of pharmacies in Nepal, most of which were private (78.3%).
Researchers reported the lowest monthly retail cost for all respiratory medications in Nepal as well as the lowest days’ wages required to afford these treatments. Robertson said there was a large disparity in the cost of treatment for mild, intermittent asthma among private pharmacies, ranging from half a days’ wage in Peru to 54 days’ wage in Uganda.
“The WHO currently targets 80% availability of these essential medications by 2025 and there’s a high variability of access and affordability of respiratory medications across the geographic settings,” Robertson said. “We call for policies aimed at decreasing value added taxes, promoting generic medications and standardizing procurement to increase the availability and affordability of these medications.”