title: Quantifying the impoverishing effects of purchasing medicines: a cross-country comparison of the affordability of medicines in the developing world.
abstract: BACKGROUND
  Increasing attention is being paid to the affordability of medicines in low- and middle-income countries (LICs and MICs) where medicines are often highly priced in relation to income levels. The impoverishing effect of medicine purchases can be estimated by determining pre- and postpayment incomes, which are then compared to a poverty line. Here we estimate the impoverishing effects of four medicines in 16 LICs and MICs using the impoverishment method as a metric of affordability.
  
  
  RESULTS
  Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because of the purchase of medicines. The prices of salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab were obtained from facility-based surveys undertaken using a standard measurement methodology. The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines.
  
  
  CONCLUSIONS
  Comparing medicine prices to available income in LICs and MICs shows that medicine purchases by individuals in those countries could lead to the impoverishment of large numbers of people. Action is needed to improve medicine affordability, such as promoting the use of quality assured, low-priced generics, and establishing health insurance systems. Please see later in the article for the Editors' Summary.
authors.affiliation: Institute for Medical Technology Assessment and Institute for Health Policy & Management, Erasmus University Rotterdam, The Netherlands. niens@bmg.eur.nl
authors.forename: Laurens M
authors.initials: LM
authors.lastname: Niëns
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cameron
authors.forename: Ellen
authors.initials: E
authors.lastname: Van de Poel
authors.forename: Margaret
authors.initials: M
authors.lastname: Ewen
authors.forename: Werner B F
authors.initials: WB
authors.lastname: Brouwer
authors.forename: Richard
authors.initials: R
authors.lastname: Laing
mesh_terms: D003431:Cross-Cultural Comparison; D003906:Developing Countries / Q000191:economics*; D018954:Drugs, Essential / Q000191:economics*; D005252:Fees, Pharmaceutical; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D011203:Poverty / Q000191:economics* / Q000208:ethnology; D014480:United Nations / Q000191:economics; D014944:World Health Organization / Q000191:economics
chemical_list: D018954:Drugs, Essential
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