They are called essential medicines — drugs that, according to the World Health Organization, “effectively and safely treat the priority healthcare needs of the population.” But availability and access remain limited in many countries, particularly low-income ones.

“It is estimated that essential medicines are unaffordable or unavailable to 1 in 4 people worldwide,” wrote the authors of a recent article published in JAMA Health Forum. Led by Olivier J. Wouters, PhD, of Brown University School of Public Health in Providence, Rhode Island, the researchers compared prices of more than 500 essential medicines across 72 markets (87 countries) of varying income levels in 2022, focusing especially on the affordability of eight drugs used to treat leading causes of death and disability worldwide.

“Little is known about the relationship between national income and drug prices. The question remains whether some poor countries routinely pay more than rich countries for the same prescription drugs, possibly owing to weaker pharmaceutical pricing policies,” the authors noted. They also highlighted the central role of essential medicines in achieving universal health coverage, which is one of the United Nations’ Sustainable Development Goals for 2030.

Nominal vs Real Prices

The analysis by Wouters and colleagues found that the availability of essential medicines ranged from 41% (225 medicines) in Kuwait to 80% (438 medicines) in Germany. Overall, the nominal price of medicines was higher in high-income countries than in low- and middle-income countries, with a positive association between GDP per capita and nominal price.

This indicates that, in general, “richer countries generally had higher drug prices,” the authors explained. But after adjusting for purchasing power, the picture changed: The real price of essential medicines was lower in wealthier nations.

The differences are clear when measured in days of minimum wage earnings needed to obtain essential medicines. For common treatments such as amoxicillin or ibuprofen, fewer than 1.2 days’ wages were needed in almost all countries. But for cancer drugs such as paclitaxel, patients in lower-middle-income countries could need more than 40 days of work.

“There is a need for international strategies aimed at achieving more equitable outcomes,” the researchers concluded.

“A high-level snapshot, at the country and regional level, disaggregated by national income status, provides useful insights but leaves many questions unanswered,” added Andrew L. Gray, PhD, from the University of KwaZulu-Natal in Durban, South Africa, in a commentary. He pointed to the many uncertainties created by confidential discounts and rebates, as well as persistent inequalities both within and between countries.

This story was translated from Univadis Italy.