11 days' wages to buy an asthma inhaler

14 medicines, 61 countries. Compare and analyse the differences between them

By Eva Belmonte and Miguel Á. Gavilanes

The same pill costs around $1000 in the United States, $320 in Spain and $554 in France. Price differences are much more striking among patented medicines like the famous Sovaldi, the new treatment against Hepatitis C, but even for generics, whose patents expired years ago, the cost disparities in different countries are remarkable. Knowing about these differences is essential to develop evidence-based policies (like Indonesia, Lebanon, Nigeria and Tajikistan have done already) and to provide data and arguments to governments and organisations for their negotiations with pharmaceutical companies. Because of this, the not-for-profit Health Action International (HAI) and the World Health Organization (WHO) have been working since 2003 on a standard methodology to collect and compare the prices, accessibility and cost structure of 14 essential drugs. None of them are patented, but that does not prevent the differences in retail prices across countries from being dramatic, especially when considering the price to income ratio in each of them.

The reports made following HAI’s methodology, the result of months of rigorous work, include the total cost breakdown (i.e. which amount goes to the manufacturer, to pay taxes or fees, to pay for transport and distribution…), its availability in pharmacies (because sometimes the access problem is not just caused by prices) and the price of both brand name drugs and generics. From this valuable set of reports we’ve extracted data for 56 countries. In order to to make comparisons between different studies, despite them having been made in different years, we look at two relative values: the ratio between the retail cost and an international reference price and, even more importantly, the hours of work needed by the citizens of each country to buy the full treatment. All calculations are based on the cheapest generic.

A citizen of a developing country has to work much longer to afford the same treatment.

To these 56 developing countries analysed by HAI we have added data about Argentina, Italy, Spain and Germany, which enables us to compare with a very different country profile. And the first conclusion is clear: a citizen of a developing country has to work much longer to afford a treatment. An example: in Nigeria or Congo, a treatment with omeprazole (30 pills) can cost almost 13 working days. In Spain, Italy and Germany, the same treatment is paid with between one or two hours’ wages.

In this case, more than ever, information is power. Therefore, various regional organisations such as UNASUR are already creating shared databases and joint procurement. So does the European Union, which approved a procurement agreement, signed by 21 of its members, to buy medical countermeasures jointly in case of the outbreak of a serious cross-border threat to health. A mechanism which, for the time being, does not cover the purchase of new drugs against Hepatitis C.

Because price is one of the main barriers to access to medicines -although not the only one,- as it drains governments’ budgets and excludes the poorest people from treatment. According to the WHO, one third of the world’s population has trouble accessing the medicines they need while, at the same time, 15% of the population consumes 90% of the global spending on pharmaceutical products.

Amitriptyline 25 mg cap/tablet

Antidepressant used for anxiety, also useful against migraine and headache.

Amoxicillin 500 mg cap/tablet

Penicillin-like antibiotic, widely used against bacterial infections.

Atenolol 50 mg cap/tablet

Used to control high blood pressure or heart diseases like angina pectoris.

Captopril 25 mg cap/tablet

Used to treat high blood pressure and protect the heart after a heart attack.

Ceftriaxone 1 g/vial injection

Antibiotic commonly used against meningitis, pneumonia or gonorrhea.

Ciprofloxacin 500 mg cap/tablet

Antibiotic used for pneumonia, urinary tract infections or sexually transmitted diseases.

Cotrimoxazole 40+200 mg/5ml suspension

An antibiotic used against certain bacterial infections, such as pneumonia or bronchitis.

Diazepam 5 mg cap/tablet

Anxiolytic used to relieve anxiety, muscle spasms and seizures.

Diclofenac 50 mg cap/tablet

Anti-inflammatory and analgesic, is used against mild or chronic pain, such as arthritis.

Glibenclamide 5 mg cap/tablet

This is one of the most commonly used hypoglycemic drugs against type 2 diabetes.

Omeprazole 20 mg cap/tablet

Gastric protector used to prevent damage to the digestive system by gastroesophageal reflux.

Paracetamol 120 mg/5ml suspension

One of the most common analgesics, routinely used against cold or flu symptoms.

Salbutamol 100 mcg/dose inhaler

Inhaler, used for asthma or obstructive respiratory diseases such as COPD.

Simvastatin 20 mg cap/tablet

Used to reduce blood cholesterol levels.

times the reference pricedays of work

  • Value
  • Sanitary System
  • Order countries by
  • Filter

Price of the cheapest generic medicine in pharmacies, compared to the international reference price (MPR)

Price of the cheapest generic medicine with a prescription, compared to the international reference price (MPR)

Days of work needed to pay for a full treatment in pharmacies

Days of work needed to pay for a full treatment in hospitals or with a public prescription

  • 11 days' wages to buy an asthma inhaler
    A citizen from Kyrgyzstan needs to work 11 days to buy an asthma inhaler (salbutamol) at a pharmacy, versus 48 minutes needed in Spain or 120 in Germany.  1
  • The daily salary of the lowest paid public servant
    In order to calculate the number of working days needed to pay for treatment, we use an official figure: the daily salary of the lowest public servant in each country.  2
  • The most expensive, a cholesterol-lowering medication
    Simvastatin, used to lower the level of cholesterol in the blood, is the least affordable drug: a patient needs almost five days of salary (4.67) on average, across 60 countries, to buy the complete treatment. On the other extreme, less than one hour of work is needed for diazepam, an anti-anxiety drug.  3
  • Where are medicines least affordable?
    If you lived in São Tomé and Príncipe you'd need to work 14 days on average to pay for the treatment of one of the 14 drugs analysed. It's the country where medicines are least affordable. Kuwait follows (7 days). On the other hand, in Italy or Spain (less than one hour of work in both of them) or Germany (an hour and a half) these essential drugs are much more accessible.  4
  • Everything is relative: let's talk about prices
    Another variable we can look at is prices. But not on absolute terms: what we analyse is the ratio between the cost of the medicine in each country and an international reference price (the green line). That allows us to compare data from studies at different points in time and visualise the outliers. If a data point goes up too much, we have a problem.  5
  • The prices in Kuwait, out of control
    This Persian Gulf country showed the biggest deviation from the international reference price in a study in 2004. Ciprofloxacin, one of the most common antibiotics, was up to 100 times the reference price in Kuwait pharmacies.  6
  • These were retail prices, what about prescriptions?
    We can also analyse these variables looking at what a patient in a public health system will end up paying, instead of retail prices in pharmacies.  7
  • The state pays, zero cost
    In many of the analysed countries, the cost of some or all of the 14 medicines is borne by the public health system, so the price paid by the patient is zero. Although the problem is sometimes not just the price, but availability: drugs out of stock, far away pharmacies...  8
  • Comparisons are odious
    Specially if we look at ciprofloxacin, an antibiotic, whose retail price at pharmacies is the most variable across the 60 analysed countries. On the public side diclofenac, an anti-inflammatory drug, is the one with the widest range of prices.  9

This interactive chart shows the data that we have collected from HAI and from several official sources in Argentina, Italy, Spain and Germany. The final dataset can be downloaded here. If you want to include information about your country to the project, learn more about our methodology and the reasons why we have used these particular datasets, you can stop by here.

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