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.
Methods and Findings: 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 facilitybased 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 ndividuals 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.