MARGARET EWEN

M.Ewen

I NVESTIGATORS of medicine prices invariably ask the question - how do prices in my country compare with those of my neighbouring country? In the past, such international comparisons have been problematic, as prices are rarely publicly accessible (especially those of developing countries). And those that are on the web are not uniform in what they represent (for example, some are reimbursement prices with or without dispensing fees, others are wholesale prices or retail prices). To aid transparency and the ability to compare price information in different settings, HAI and EDM have published a database of results submitted by those who have undertaken price surveys using the new methodology. The database is freely accessible on HAI's web site at http://www.haiweb.org/medicineprices Figure 1 shows the three sections.

Figure 1. Sections of the medicine price database

Undertaking a survey

Survey managers will find here all the information needed to undertake a price survey. The manual and computerised workbook can be downloaded and, importantly, updates to the manual are published here (including the latest MSH reference prices see page 17). In addition there are some FAQs and information is given on how to get help (if needed). New information is continually being added.

Survey results

National survey data are lodged here in a standard format. By comparing individual survey results, international comparisons can be made of:

• the price ratios of individual originator brand or generic medicines, from each sector, on the core list

• the affordability of selected courses of treatment, measured against each country's public sector minimum wage

• the composition of the retail price of a medicine in different countries.

Contact details of survey managers are given (for any queries), plus any supporting documents, for example, the completed national pharmaceutical sector form (to contextualise price data), any training material used to train data collectors, the survey report and briefing papers.

Database

The 'query the database' section of the website is proving popular - which is not surprising as it allows for speedy comparisons of data. Currently you can carry out a query according to price or to affordability.

To query prices you can choose between:

(i) one medicine, many surveys

Here you can compare price ratios for an individual medicine, by sector, in all countries where data were collected. It is a simple 3-step process:

On the screen you will then see the median price ratios for the originator brand, most sold generic and lowest-price generic of that medicine (along with the 25^th and 75^th percentile price ratios). To illustrate this, Figure 2 shows the outcome of a query for fluconazole 200 mg tablets, private sector retail pharmacy prices and all surveys.

Figure 2. A query for fluconazole

(ii) one survey, many medicines

Again, it is straightforward:

By selecting summary data, you get a snapshot of the overall price differences between originator brands and generics in a sector. These differences translate to savings for the patient.

If you wish to carry out a query on affordability then you can choose between:

(i) one condition, many surveys

Select the condition/medicine you are interested in.

On screen you will see data for all surveys that involved the selected condition and medicine. Figure 3 shows the number of day's wages needed to pay for a month's ulcer treatment with ranitidine 150 mg tablets in South Africa, Sri Lanka and Armenia.

Figure 3. No. of day's wages needed to treat an ulcer with ranitidine in South Africa, Sri Lanka and Armenia

(ii) one survey, many conditions

Select the survey you are interested in. You will be given affordability data on all the conditions that were involved in the selected survey. See figure 4.

Figure 4. Affordability data

The best way to see what data are available is to go to the web site and submit one of these queries or view individual survey results.

What are the major differences between this price database and others? Other databases give the medicine price in local currency. This database gives the median price ratio for each medicine i.e. the local median price, converted to US dollars, compared to a reference price (all current data on the web site use 2001 MSH prices). This approach provides a measurement against which prices can be compared. Also, this database is all about what people pay for medicines - which isn't so common.

This database should provide much needed transparency and information about the prices people pay for medicines. But it is evolving - and its value depends entirely on investigators conducting surveys and submitting their results.