There are no contemporary data on the availability, cost, and affordability of essential medicines for the chronic respiratory diseases (CRDs) asthma and chronic obstructive pulmonary disease (COPD) across low-income and middle-income countries (LMICs).
Cross-sectional data on the availability and cost of CRD medicines in a pharmacy, healthcare facility (HCF) and central medicine store (CMS) in LMICs were collected. Costs were summarised in US Dollar equivalents as medians with interquartile ranges (IQR). A medicine was affordable if one month’s treatment cost was <1 day’s wages of the lowest paid government worker.
Data were collected from 60 LMICs.
Inhaled short-acting beta-agonists (SABA) were available in pharmacies of 53/57(93%) LMICs ($2.95,IQR:$1.99-4.97), 44/56(79%) HCFs ($2.34,IQR:$1.38-3.86) and 36/46(78%) CMS ($1.39,IQR:$1.20-2.83). They were affordable in 29/51(57%) pharmacies and 31/44(70%) HCFs.
Inhaled corticosteroids (ICS) were available in 31/57(54%) pharmacies ($5.40,IQR:$2.12-8.60), 31/46(67%) HCFs ($3.01,IQR:$1.21-5.89) and 22/46(48%) CMS ($1.16,IQR:$0.11-3.24). ICS were affordable in 17/31(55%) pharmacies and 20/31(65%) HCFs.
Combination ICS-long-acting beta-agonists (200+6mcg/dose budesonide-formoterol) were available in 31/57(54%) pharmacies ($19.20,IQR:$9.73-27.43), 21/56(38%) HCFs ($18.41,IQR:$11.30-24.49) and 9/46(20%) CMS ($7.14,IQR:$3.90-8.13). ICS-LABA were affordable in 6/31(19%) pharmacies and 3/20(15%) HCFs.
Long-acting anti-muscarinic antagonists (LAMA) were available in 26/57(46%) pharmacies ($30.53,IQR:$9.45-47.29), 16/56(29%) HCFs ($26.01,IQR:$15.32-36.70) and 11/46(24%) CMS ($17.98,IQR:$0.98-32.17). LAMA were affordable in 4/25(16%) pharmacies and 2/16(13%) HCFs.
Inhaled SABA were largely available and affordable whilst ICS, ICS-LABA and LAMA were less widely available and largely unaffordable. Costs ranged between countries with substantial differences between CMS and pharmacy or HCF within countries.