Advertisement

An Analysis of Accessibility of Representative Psychotropic Medicine From the World Health Organization Model List of Essential Medicines in Developing Countries With Different Income Levels

  • Author Footnotes
    ∗ Yangfan Shi and Lingli Zhang contributed equally to this work and should be regarded as co-first authors.
    Yangfan Shi
    Footnotes
    ∗ Yangfan Shi and Lingli Zhang contributed equally to this work and should be regarded as co-first authors.
    Affiliations
    School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China

    The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China
    Search for articles by this author
  • Author Footnotes
    ∗ Yangfan Shi and Lingli Zhang contributed equally to this work and should be regarded as co-first authors.
    Lingli Zhang
    Footnotes
    ∗ Yangfan Shi and Lingli Zhang contributed equally to this work and should be regarded as co-first authors.
    Affiliations
    School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
    Search for articles by this author
  • Jianan Fu
    Affiliations
    School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China

    The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China
    Search for articles by this author
  • Rong Shao
    Affiliations
    School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China

    The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China
    Search for articles by this author
  • Jianzhou Yan
    Correspondence
    Correspondence: Correspondence: Jianzhou Yan, PhD, The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu 211198, People’s Republic of China.
    Affiliations
    School of International Business, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China

    The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, Jiangsu, People’s Republic of China
    Search for articles by this author
  • Author Footnotes
    ∗ Yangfan Shi and Lingli Zhang contributed equally to this work and should be regarded as co-first authors.
Published:November 25, 2022DOI:https://doi.org/10.1016/j.jval.2022.11.009

      Highlights

      • The low level of accessibility of psychotropic medicine in developing countries, especially in low-income countries, seriously hinders patients’ long-term access to psychotropic medicine.
      • In developing countries, even though the accessibility of generic medicine is higher than that of branded medicine, the procurement and patient prices of generic medicines remain much higher than international reference prices, and the availability and affordability of generic medicine remain at the nonideal level.
      • To further improve accessibility of psychotropic medicine, developing countries, especially low-income countries, can encourage patients to substitute generic medicine for branded medicines while adopting efficient procurement mechanisms.

      Abstract

      Objectives

      The objective of this study was to analyze the accessibility of psychotropic medicine in developing countries based on the availability, price, and affordability indicators to create international evidence to guide the development of policies on the accessibility of medicines.

      Methods

      This study included 5 types of psychotropic medicines listed in the 22nd edition of the World Health Organization Model List of Essential Medicines published by the World Health Organization in 2021. Derived from 84 surveys in 59 countries, this study summarizes the availability, price, and affordability of originator branded drugs (OBs) and lowest-price generic drugs (LPGs) in the public and private sectors and compares them based on income levels in different countries.

      Results

      The average availability of psychotropic medicine was 45% in low- and lower-middle-income countries (LLMICs) compared with 49% in high- and upper-middle-income countries (HUMICs) whereas the availability of LPGs was higher than that of OBs in all country groups. The average patient price for OBs and LPGs was 94.0 and 23.2, respectively, and the overall patient price of psychotropic medicine in LLMICs was higher than that in HUMICs. The affordability of psychotropic medicine in LLMICs was lower than that in HUMICs.

      Conclusions

      Psychotropic medicines in lower-middle-income countries have lower availability, a higher average patient price, and lower average affordability than in HUMICs, which requires lower-middle-income countries to take effective and various measures to improve the accessibility of psychotropic medicine.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Value in Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis [published correction appears in JAMA Psychiatry. 2015;72(7):736] [published correction appears in JAMA Psychiatry. 2015;72(12):1259]. JAMA Psychiatry. 2015;72(4):334-341.

        • Brådvik L.
        Suicide risk and mental disorders.
        Int J Environ Res Public Health. 2018; 15: 2028
        • Bhavsar V.
        • Bhugra D.
        Violence towards people with mental illness: assessment, risk factors, and management.
        Psychiatry Clin Neurosci. 2018; 72: 811-820
        • Choe J.Y.
        • Teplin L.A.
        • Abram K.M.
        Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns.
        Psychiatr Serv. 2008; 59: 153-164
        • Keepers G.A.
        • Fochtmann L.J.
        • Anzia J.M.
        • et al.
        The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia.
        Am J Psychiatry. 2020; 177: 868-872
        • Lyu R.R.
        • McCombs J.S.
        • Johnstone B.M.
        • Muse D.N.
        Use of conventional antipsychotics and the cost of treating schizophrenia.
        Health Care Financ Rev. 2001; 23: 83-99
        • Charlson F.J.
        • Baxter A.J.
        • Dua T.
        • Degenhardt L.
        • Whiteford H.A.
        • Vos T.
        Excess mortality from mental, neurological, and substance use disorders in the Global Burden of Disease Study 2010.
        Epidemiol Psychiatr Sci. 2015; 24: 121-140
        • Whiteford H.A.
        • Degenhardt L.
        • Rehm J.
        • et al.
        Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.
        Lancet. 2013; 382: 1575-1586
        • Cameron A.
        • Ewen M.
        • Ross-Degnan D.
        • Ball D.
        • Laing R.
        Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis [published correction appears in Lancet. 2009;373(9664):632].
        Lancet. 2009; 373: 240-249
        • Cameron A.
        • Roubos I.
        • Ewen M.
        • Mantel-Teeuwisse A.K.
        • Leufkens H.G.
        • Laing R.O.
        Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries.
        Bull World Health Organ. 2011; 89: 412-421
        • Cameron A.
        • Bansal A.
        • Dua T.
        • et al.
        Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries.
        Epilepsia. 2012; 53: 962-969
        • McBain R.
        • Norton D.J.
        • Morris J.
        • Yasamy M.T.
        • Betancourt T.S.
        The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries.
        PLoS Med. 2012; 9e1001166
        • Saraceno B.
        • van Ommeren M.
        • Batniji R.
        • et al.
        Barriers to improvement of mental health services in low-income and middle-income countries.
        Lancet. 2007; 370: 1164-1174
      2. World Health Organization model list of essential medicines 22nd list. World Health Organization.
      3. Measuring medicine prices, availability, affordability and price components. 2nd ed. World Health Organization.
      4. International medical products price guide. Management Sciences for Health (MSH).
        http://mshpriceguide.org/en/home/
        Date accessed: June 8, 2022
      5. International Financial Statistics (IFS). International Monetary Fund.
        • How does the World Bank classify countries?
        The World Bank.
        • Historical classification by income in XLSX format
        The World Bank.
      6. An international comparison of chronic disease medicines. World Health Organization, Regional Office for the Eastern Mediterranean Price, Availability and Affordability.
        • Yang H.
        • Dib H.H.
        • Zhu M.
        • Qi G.
        • Zhang X.
        Prices, availability and affordability of essential medicines in rural areas of Hubei Province.
        China Health Policy Plan. 2010; 25: 219-229
      7. Equitable access to essential medicines: a framework for collective action. World Health Organization.
        • Husain M.J.
        • Datta B.K.
        • Kostova D.
        • et al.
        Access to cardiovascular disease and hypertension medicines in developing countries: an analysis of essential medicine lists, price, availability, and affordability [published correction appears in J Am Heart Assoc. 2020;9(10):e014543].
        J Am Heart Assoc. 2020; 9e015302
      8. MDG Gap Task Force. Delivering on the Global Partnership for Achieving the Millennium Development Goals: Millennium Development Goal 8: MDG Gap Task Force Report 2008. United Nations Publications. https://www.un.org/millenniumgoals/pdf/MDG%20Gap%20Task%20Force%20Report%202008.pdf. Accessed June 8, 2022.