LSTM Home > LSTM Research > LSTM Online Archive

The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review.

Stolbrink, Marie, Thomson, Helen, Hadfield, Ruth M, Ozoh, Obianuju B, Nantanda, Rebecca, Jayasooriya, Shamanthi, Allwood, Brian, Halpin, David M G, Salvi, Sundeep, de Oca, Maria Montes, Mortimer, Kevin and Rylance, Sarah (2022) 'The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review.'. Lancet Global Health, Vol 10, Issue 10, e1423-e1442.

PIIS2214109X22003308.pdf - Published Version
Available under License Creative Commons Attribution.

Download (7MB) | Preview


Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs. A systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069. Of 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity. Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. WHO and Wellcome Trust.

Item Type: Article
Additional Information: This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WF Respiratory System > WF 20 Research (General)
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 22 Nov 2022 12:00
Last Modified: 06 Jun 2023 16:30


View details

Actions (login required)

Edit Item Edit Item