Access to asthma medicines in resource-limited settings: A cross-sectional study in Enugu State, Nigeria

Abstract

Background The high cost of asthma management in low- and middle-income nations contributes to poor disease control. This study evaluated the prices, availability, and affordability of selected asthma medicines in Enugu State, Nigeria. Methods This cross-sectional survey (February 2024 – March 2024) was conducted in community pharmacies in Enugu State, Nigeria using the Medicine Price Data Collection Form. Data were obtained for Originator Brands (OB) and Lowest-Priced Generics (LPG) of 23 asthma medicines. Median Price Ratios (MPR) was calculated using South Africa’s International Reference Unit Prices (IRP). Results Ninety survey forms were completed. MPRs were calculated for 10 medicines; six exceeded one. The OB of salbutamol 100 mcg inhaler was 5.2 times the reference price. Average availability across OBs (3.1%), LPGs (13.3%), and all medicines (8.2%) was below the 80% benchmark. All OBs and most LPGs (78.6%) cost more than a day’s wage. Managing asthma with salbutamol inhaler required 7.5 days’ wages for OB and 4.0 days for LPG. Salmeterol/fluticasone (50/250 mcg) Diskus ® required 42.0 days’ wages. Conclusion Asthma medicines in Enugu State were costly, scarce, and unaffordable. Expanding health insurance, providing subsidies, and promoting local production are essential to improve access and control outcomes.