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Wealthy countries pay more for essential medicines, but the cost burden is far lower, study finds


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Wealthy countries may pay steep prices for medicines, but once their purchasing power is factored in, they actually benefit from some of the lowest costs in the world, a new study has found.

The analysis of 549 essential medicines across 72 markets worldwide reveals major disparities in affordability between wealthier and poorer countries – even though rich countries often pay higher list prices.

While poorer nations often have lower list prices, people in those countries tend to shoulder a far greater financial burden, according to the study, which was published in the journal JAMA Health Forum.

In parts of Africa and Southeast Asia, critical medicines can cost the lowest-income earners several weeks’ worth of wages if they have to pay out of pocket.

The 549 drugs included in the study were sourced from the World Health Organization’s (WHO) essential medicines list, which tallies the most important medicines for health systems to function.

They include everything from over-the-counter painkillers to antibiotics, anaesthetics, and mental health drugs.

No country stocked every drug, with availability ranging from 438 medicines in Germany to 225 in Kuwait. Across the 33 European countries included in the study, the average was 367 medicines.

The study found that treatments for mental and behavioural disorders and cardiovascular disease tended to be the most expensive, while drugs for hepatitis B and C were generally the cheapest.

European countries spent the most on essential medicines – $2 billion (€1.74 billion) overall and $192 (€167) per capita. At the other end of the spectrum, the Americas spent $1 billion (€868 million) overall and Southeast Asia spent $7 (€6) per capita in 2022.

However, a medicine’s list price – the sticker price set by a drugmaker before any discounts, subsidies, or insurance are taken into account – can be misleading. Cost of living and the government’s role in setting drug prices vary around the world.

To better reflect affordability, researchers used Germany as a benchmark and adjusted prices for local purchasing power.

They found that medicine prices in Lebanon were roughly one-fifth of German prices, while in Argentina, prices were nearly six times as high as in Germany.

In Pakistan, for example, drug prices may be lower on paper, but once purchasing power is factored in, they’re about the same as in Germany. And in the United States, prices reached three times the German level.

Meanwhile in India, minimum-wage earners would need about 10 days of work to afford a monthlong dose of tenofovir disoproxil, which treats chronic hepatitis B and helps prevent and treat HIV/AIDS.

For the chemotherapy drug paclitaxel, minimum-wage labourers in lower-income countries would need to work for nearly six weeks to pay for a monthlong course of the treatment.

“Some poorer countries face a higher burden of medication costs, even if the price for the same medicine is lower compared to richer countries,” the researchers said.



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