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Background: Most cancer drugs enter the US market first. US Food and Drug Administration (FDA) approvals of new cancer drugs may influence regulatory decisions in other settings. The study examined whether characteristics of available evidence at FDA approval influenced time-to-marketing authorisation (MA) in Brazil, and price differences between the two countries. Methods: All new FDA-approved cancer drugs from 2010 to 2019 were matched to drugs with MA and prices approved in Brazil by December 2020. Characteristics of main studies, availability of randomised controlled trials (RCTs), overall survival (OS) benefit, added therapeutic benefit, and prices were compared. Findings: Fifty-six FDA-approved cancer drugs with matching indications received a MA at the Brazilian Health Regulatory Agency (Anvisa) after a median of 522 days following US approval (IQR: 351–932). Earlier authorisation in Brazil was associated with availability of RCT (median: 506 vs 760 days, p = 0.031) and evidence of OS benefit (390 vs 543 days, p = 0.019) at FDA approval. At Brazilian marketing authorisation, a greater proportion of cancer drugs had main RCTs (75% vs 60.7%) and OS benefit (42.9% vs 21.4%) than that in the US. Twenty-eight (50%) drugs did not demonstrate added therapeutic benefit over drugs for the same indication in Brazil. Median approved prices of new cancer drugs were 12.9% lower in Brazil compared to the US (adjusted by Purchasing Power Parity). However, for drugs with added therapeutic benefit median prices were 5.9% higher in Brazil compared to the US, while 17.9% lower for those without added benefit. Interpretation: High-quality clinical evidence accelerated the availability of cancer medicines in Brazil. The combination of marketing and pricing authorisation in Brazil may favour the approval of cancer drugs with better supporting evidence, and more meaningful clinical benefit albeit with variable degree of success in achieving lower prices compared to the US. Funding: None.

Background To strengthen appropriate medicine use (AMU) including the prescribing and dispensing quality at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged approach known as the Supervision, Performance Assessment, and Recognition Strategy (SPARS). This paper assesses the impact of the first year of SPARS implementation on key AMU indicators. Methods District-based health workers trained as supervisors provide in-service training in medicines management complemented by indicator-based performance assessment and targeted supervision during each SPARS facility visit. From 2010 to 2013, health facilities that started the SPARS intervention were assessed during the first and last visit during a period of 12 months of implementing SPARS. This study examines 12 AMU indicators with 57 individual outcomes covering prescribing and dispensing quality. We also explored factors influencing 1-year improvement. Results We found an overall increase in AMU indicators of 17 percentage points (p < 0.000) between the first and last visit during a period of 12 months of supervisions, which was significant in all levels of health care facilities and in both government and private not-for-profit faith-based sectors. Appropriate dispensing (25 percentage points, p < 0.005) improved more than appropriate prescribing (12 percentage points, p = 0.13). Specific facilities that reached an average score of over 75% across all AMU measures within the first year of supervision improved from 3 to 41% from the first visit (baseline). The greatest overall impact on AMU occurred in lower-level facilities; the level of improvement varied widely across indicators, with the greatest improvements seen for the lowest baseline measures. Supervision frequency had a significant impact on level of improvement in the first year, and private not-for-profit faith-based health facilities had notably higher increases in several dispensing and prescribing indicator scores than public sector facilities. Conclusions The multipronged SPARS approach was effective in building appropriate medicine use capacity, with statistically significant improvements in AMU overall and almost all prescribing and dispensing quality measures after 12 months of supervision. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen appropriate medicine use in low-income countries.

To assess sales of anti-cancer medicines in the 2017 World Health Organization'sWe extracted sales volume data for 39 anti-cancer medicines from the IQVIA database. We divided the total quantity sold by the reference defined daily dose to estimate the total number of defined daily doses sold, per country per year, for three types of anti-cancer therapies (traditional chemotherapy, targeted therapy and endocrine therapy). We adjusted these data by the number of new cancer cases in each country for each year.We observed an increase in sales across all types of anti-cancer therapies in all countries. The largest number of defined daily doses of traditional chemotherapy per new cancer case was sold in Thailand; however, the largest relative increase per new cancer case occurred in Indonesia (9.48-fold). The largest absolute and relative increases in sales of defined daily doses of targeted therapies per new cancer case occurred in Kazakhstan. Malaysia sold the largest number of adjusted defined daily doses of endocrine therapies in 2017, while China and Indonesia more than doubled their adjusted sales volumes between 2007 and 2017.The use of sales data can fill an important knowledge gap in the use of anti-cancer medicines, particularly during periods of insurance coverage expansion. Combined with other data, sales volume data can help to monitor efforts to improve equitable access to essential medicines.Évaluer la vente de médicaments contre le cancer figurant dans l'édition 2017 de laNous avons extrait de la base de données IQVIA les informations relatives au volume de vente pour 39 médicaments contre le cancer. Nous avons divisé le nombre total de médicaments vendus par la dose quotidienne déterminée de référence, afin d'estimer le nombre total de doses quotidiennes déterminées vendues par pays et par an, pour trois types de traitements contre le cancer (chimiothérapie conventionnelle, thérapie ciblée et endocrinothérapie). Nous avons ajusté ces données en tenant compte du nombre de nouveaux cas de cancer diagnostiqués chaque année dans chaque pays.Nous avons observé une hausse des ventes pour tous les types de traitements contre le cancer dans tous les pays. C'est la Thaïlande qui vend le plus grand nombre de doses quotidiennes déterminées en chimiothérapie conventionnelle pour chaque nouveau cas de cancer; néanmoins, c'est en Indonésie que nous avons constaté la plus grande augmentation relative pour chaque nouveau cas de cancer (nombre multiplié par 9,48). En termes d'augmentation absolue et relative des ventes de doses quotidiennes déterminées pour lathérapie ciblée, c'est au Kazakhstan qu'elle était la plus élevée. La Malaisie est le pays ayant vendu le plus grand nombre de doses quotidiennes déterminées pour l'endocrinothérapie, tandis que la Chine et l'Indonésie ont plus que doublé leur volume de vente ajusté entre 2007 et 2017.L'exploitation des données de vente peut combler un manque de connaissances dans l'utilisation de médicaments contre le cancer, surtout pendant les périodes d'élargissement de la couverture maladie. En les associant à d'autres informations, les données sur le volume de vente permettent de suivre les efforts fournis pour garantir un accès de plus en plus équitable aux médicaments essentiels.Evaluar las ventas de los medicamentos contra el cáncer que aparecen en laLos datos sobre el volumen de ventas de 39 medicamentos contra el cáncer se obtuvieron de la base de datos IQVIA. Se dividió la cantidad total que se vendió por la dosis diaria definida de referencia para estimar el número total de dosis diarias definidas que se vendieron, por país y por año, para tres tipos de tratamientos anticancerosos (quimioterapia tradicional, terapia dirigida y tratamiento endocrino). Se adaptaron estos datos por el número de nuevos casos de cáncer en cada país para cada año.Se observó un incremento en las ventas de todos los tipos de tratamientos anticancerosos en todos los países. El mayor número de dosis diarias definidas de quimioterapia tradicional por cada nuevo caso de cáncer se vendió en Tailandia; sin embargo, el mayor incremento relativo por cada nuevo caso de cáncer se registró en Indonesia (9,48 veces). Los mayores incrementos absolutos y relativos de las ventas de dosis diarias definidas de las terapias dirigidas por cada nuevo caso de cáncer se registraron en Kazajstán. Malasia vendió el mayor número de dosis diarias definidas adaptadas de los tratamientos endocrinos en 2017, mientras que China e Indonesia duplicaron con creces sus volúmenes de ventas ajustadas entre 2007 y 2017.El empleo de los datos de ventas puede llenar un importante vacío de conocimientos sobre el uso de los medicamentos contra el cáncer, en particular durante los periodos de la ampliación de la cobertura de los seguros. Los datos sobre el volumen de ventas, junto con otros datos, pueden ayudar a supervisar los esfuerzos por mejorar el acceso equitativo a los medicamentos esenciales.الغرض تقييم مبيعات أدوية مكافحة السرطان في القائمة النموذجية للأدوية الأساسية لمنظمة الصحة العالمية (WHO) لعام 2017 في كل من الصين وإندونيسيا وكازاخستان وماليزيا والفلبين وتايلند، من عام 2007 (2008 بالنسبة لكازاخستان وماليزيا) حتى عام 2017. الطريقة قمنا باستخلاص بيانات حجم المبيعات لعدد 39 دواءً مكافحاً للسرطان من قاعدة بيانات IQVIA. قمنا بتقسيم إجمالي الكمية المباعة بالجرعة اليومية المرجعية المحددة، وذلك لتقدير إجمالي عدد الجرعات اليومية المحددة المباعة، لكل بلد سنوياً، لثلاثة أنواع من العلاجات المكافحة للسرطان (العلاج الكيميائي التقليدي، والعلاج الموجه، والعلاج بالغدد الصماء). قمنا بتعديل هذه البيانات حسب عدد حالات السرطان الجديدة في كل دولة لكل عام. النتائج لاحظنا زيادة في مبيعات كل أنواع العلاجات المكافحة للسرطان في كل الدول. تم بيع أكبر عدد من الجرعات اليومية المحددة من العلاج الكيميائي التقليدي، لكل حالة سرطان جديدة، في تايلند؛ ومع ذلك، حدثت أكبر زيادة نسبية لكل حالة سرطان جديدة في إندونيسيا (9.48 ضعفاً). حدثت أكبر زيادات مطلقة ونسبية في مبيعات الجرعات اليومية المحددة من العلاجات المستهدفة لكل حالة سرطان جديدة، في كازاخستان. باعت ماليزيا أكبر عدد من الجرعات اليومية المعدلة من علاجات الغدد الصماء في عام 2017، بينما باعت الصين وإندونيسيا أكثر من ضعف حجم مبيعاتهما المعدلة بين عامي 2007 و2017. الاستنتاج إن استخدام بيانات المبيعات يمكنه أن يسد فجوة معرفية هامة في استخدام أدوية مكافحة السرطان، وخاصة خلال فترات تمديد التغطية التأمينية. يمكن لبيانات حجم المبيعات، إلى جانب بيانات أخرى، أن تساعد في مراقبة الجهود لتحسين الوصول العادل إلى الأدوية الأساسية.旨在评估世界卫生组织发布的我们从 IQVIA 数据库中选取了 39 种抗癌药物的销量数据。我们用销售总量除以此参考清单中的限定日剂量来估算每个国家三种抗癌疗法（传统化疗、靶向治疗和内分泌疗法）每年的限定日剂量总销量。我们根据每个国家每年新增癌症病例数调整了这些数据。.我们观察到所有国家各种类型的抗癌疗法的销售额都有所增长。泰国每例新增癌症患者购买传统化疗药物的限定日剂量最大；然而，印度尼西亚每例新增癌症患者的相对增幅最大（9.48 倍）。哈萨克斯坦的新增癌症患者中，靶向治疗的限定日剂量销售额呈现最大的绝对增幅和相对增幅。2017 年，马来西亚调整后的内分泌疗法限定日剂量销量最大，而中国和印度尼西亚的调整后销售量在 2007 年至 2017 年增加了一倍以上。.销售数据的使用可以填补抗癌药物使用方面的重要认知缺口，尤其是在扩大保险覆盖范围期间。结合其他数据，销量数据有助于监测改善患者平等获取基本药物方面的工作。.Оценить уровень продаж противораковых препаратов из изданного Всемирной организацией здравоохранения в 2017 годуАвторы получили данные о продажах 39 противораковых препаратов из базы данных IQVIA. Общее количество проданных единиц было разделено на эталонную условную суточную дозу для оценки общего количества условных суточных доз, проданных в конкретной стране за год. Рассматривались три типа противораковых препаратов: традиционная химиотерапия, таргетная и гормональная терапия. Данные затем были скорректированы по количеству новых случаев рака в каждой стране за каждый год.Наблюдался рост продаж по всем типам противораковых препаратов в каждой из стран. Максимальное количество условных суточных доз традиционной химиотерапии на новый случай рака было продано в Таиланде, однако максимальный относительный прирост по каждому новому случаю продемонстрировала Индонезия (рост в 9,48 раза). Максимальный абсолютный и относительный прирост продаж условных суточных доз препаратов для таргетной терапии на новый случай рака продемонстрировал Казахстан. Малайзия стала лидером по продажам скорректированных условных суточных доз препаратов для гормональной терапии в 2017 году, а в период с 2007 по 2017 год Индонезия и Китай увеличили скорректированные объемы продаж более чем вдвое.Использование данных продаж поможет восполнить значительный пробел в знаниях о применении противораковых препаратов, в частности в периоды расширения страхового покрытия. В сочетании с другими данными показатели объемов продаж помогут отслеживать усилия по обеспечению равного доступа населения к основным лекарственным средствам.

IntroductionNew targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending.MethodsUsing a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017.ResultsAfter the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146).ConclusionsThe 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.

COVID-19 coronavirus pandemic has virtually locked down the entire world of human population, and through its rapid and unstoppable spread COVID-19 has essentially compartmentalised the population merely into susceptible, exposed, infected and recovered classes. Adapting the classical epidemic modelling framework, two distinct routes of COVID-19 transmission are incorporated into a model: (a) direct person-to-person contact transmission, and (b) indirect airborne and fomites-driven transmission. The indirect non-contact transmission route needs to explored in models of COVID-19 spread, because evidences show that this route of transmission is entirely viable with hugely uncertain level of relative contribution. This theoretical study based on model simulations demonstrates the following: (1) Not incorporating indirect transmission route in the model leads to underestimation of the basic reproduction number, and hence will impact on the COVID-19 mitigation decisions; (2) Lockdown measures can suppress the primary infection peak, but will lead to a secondary peak whose relative strength and time of occurrence depend on the success and duration of the lockdown measures; (3) To make lockdown effective, a considerable level of reduction in both contact and non-contact transmission rates over a long period is required; (4) To bring down the infection cases below any hypothetical health-care capacity, reduction of non-contact transmission rate is key, and hence active measures should be taken to reduce non-contact transmission (e.g., extensive uses of areal and aerosol disinfectant in public spaces to improve contaminated surfaces and air); (5) Any premature withdrawal of lockdown following the sign of a brief retracement in the infection cases can backfire, and can lead to a quicker, sharper and higher secondary peak, due to reactivation of the two transmission routes. Based on these results, this study recommends that any exit policy from lockdown, should take into account the level of transmission reduction in both routes, the absolute scale of which will vary among countries depending on their health-service capacity, but should be computed using accurate time-series data on infection cases and transmission rates.

A strong pharmaceutical sector is a precondition for effective and efficient health care and financing systems, and thus for achieving the best possible health of a population. Supported by visionary, long-term donor funds, in conjunction with mutual trust, the USAID-funded Securing Ugandans Rights to Essential Medicines (SURE) and Uganda Health Supply Chain (UHSC) program engaged in a close, more than 10 year-long (in 2018) collaboration with the Ministry of Health of Uganda. Over time, the partnership implemented numerous multi-pronged comprehensive changes in the pharmaceutical sector and conducted research to document successes and failures. We describe the evolution and key characteristics of the SURE/UHSC interventions.

Основные лекарства удовлетворяют приоритетные потребности населения в области здравоохранения. Политика, основанная на концепции основных лекарств, имеет решающее значение в улучшении здоровья и достижении устойчивого развития. Цель устойчивого развития 3.8 конкретно упоминает важность «доступности безопасных, эффективных, качественных и доступных по цене основных лекарств и вакцин для всех» в качестве центрального компонента всеобщего охвата медицинской помощью (ВОМП), а цель устойчивого развития 3.b подчёркивает необходимость разработки лекарств для устранения постоянно возникающих пробелов в отношении лечения. Признание важности основных лекарств - не новость. В 1985 г. на конференции в Найроби по рациональному использованию лекарств представители правительств и другие заинтересованные стороны предложили всеобъемлющий комплекс мер по разработке политики в области основных лекарств. Через 30 лет была созвана «Комиссия журнала Ланцет (Lancet) по основным лекарствам» (далее Комиссия) для изучения следующих вопросов: Какого прогресса удалось достичь? Какие проблемы ещё остаются для решения? Какие уроки были извлечены для информирования будущих подходов? И как можно использовать политику в области основных лекарств для продвижения ВОМП и внесения вклада в повестку глобального устойчивого развития? В настоящем докладе рассмотрены эти вопросы с намерением репозиционировать политику в области основных лекарств в повестке глобального развития. Комиссия определила пять областей, имеющих решающее значение для политики в области основных лекарств: оплата корзины основных лекарств, обеспечение ценовой доступности основных лекарств, гарантия их качества и безопасности, мероприятия, способствующие их качественному использованию, и разработка недостающих (отсутствующих) основных лекарств. Комиссия позиционировала политику в области основных лекарств в контексте текущих глобальных дебатов о балансировании политики в области торговли и интеллектуальной собственности с правами человека, об обеспечении безопасности здравоохранения, укреплении систем здравоохранения, ориентированных на людей, и улучшении доступности основных технологий. Во всех областях политики особое внимание было уделено совершенствованию принципов равенства и справедливости в доступе, укреплению соответствующих институтов и созданию подотчётности. В каждой из определённых областей Комиссия сформулировала рекомендации к действию, подтвердив тем самым позицию политики в области основных лекарств в качестве центрального компонента глобального здоровья и здравоохранения и повестки развития.

Methods Using an interrupted time series design, we conducted segmented regression analyses of utilization changes of targeted anti-cancer medicines covered by the provincial government health insurance program during 2013 to 2016 in 69 hospitals with more than 100 beds in Hangzhou, the capital city of Zhejiang province of China. The WHO/Health Action International Project on Medicine Prices and Availability methodology was used to measure patient affordability of the study medicines. Results In March 2015, the utilization of all study medicines increased by 15.58 (95% CI = 3.86, 27.30, P = 0.01) to 439.14 standard units (95% CI = 311.79, 566.49, P

ObjectivesTo assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients.MethodsLongitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient admissions, expenditure per common disease outpatient (CD/OP) visit and prescribing indicators over time. We conducted segmented regression analyses of interrupted time series data to measure changes in level and trend overtime, and cross-sectional comparisons against external standards.ResultsThe number of total outpatient visits at 46 primary care facilities (on the CD/OP benefit as of July 2012) increased by 46 895 visits/month (P = 0.004, 95% CI: 15 795-77 994); the average number of CD/OP visits reached 1.84/year/enrollee in 2012; monthly inpatient admissions dropped from 6.4 (2009) to 4.3 (2012) per 1000 enrollees; the median total expenditure per CD/OP visit dropped by CNY 15.40 (P = 0.16, 95% CI: -36.95 similar to 6.15); injectable use dropped by 7.38% (P = 0.03, 95% CI: -14.08%similar to-0.68%); antibiotic use was not improved.ConclusionsZhuhai's new CD/OP benefit with capitated provider payment has expanded access to primary care, which may have led to a reduction in expensive specialist inpatient services for CD/OP benefit enrollees. Cost awareness was likely raised, and rapidly growing expenditures were contained. Although having been partially improved, inappropriate prescribing of antibiotics and injectables was still prevalent. More explicit incentives and specific quality of care targets must be incorporated into the capitated provider payment to promote scientifically sound and cost-effective care and treatment.

Objectives New antidiabetic medications such as insulin analogues and thiazolidinediones have been introduced over the last decade. This study compares the uptake of new agents in three emerging pharmaceutical markets: Brazil, China, and Thailand. Methods Using longitudinal IMS Health sales data, we calculated the quarterly percentage market share for types of insulins and oral hypoglycemic agents from 2002 through 2012 in each country. New oral hypoglycemic agents included: alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, and non-sulfonylurea secretagogues. Results While China had the highest use of insulin cartridges and pens (85.6% in 2010), Brazil was the earliest adopter of insulin analogues and had the greatest use of these products overall (44.6% of the insulin market) in 2010, which then decreased by almost half by 2012. Together, sulfonylureas and metformin dominated the markets in Brazil and Thailand (~89% and ~96% respectively) over the 10-year period. Between 2002 and 2012, there was a shift in use from sulfonylureas to metformin; the market share of newer agents remained 10% or less in both countries. In China, however, market share of new oral agents grew rapidly from 13.1% to 44.4%. While metformin use was relatively stable in China (one-third of the market), sulfonylureas declined substantially over the 10-year period (41.5% to 20.8%). Conclusion Given large cost differentials between newer and older insulins and among oral hypoglycemic agents, it is important to evaluate uptake of newer products over time. Uptake patterns differed in the study countries, likely due to different medicines policy approaches. Future research should evaluate how trends in use of antidiabetic products align with national clinical practice guidelines and pharmaceutical policies, as well as the impacts of different patterns of use on cost and clinical outcomes.

Background Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. Methods We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. Results We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c Conclusions EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.

This study developed a new measure of medication affordability that examines out-of-pocket drug expenses relative to available household resources. The authors assessed the spending patterns of approximately 2.1 million poor households (< or =100% federal poverty level) of adults aged 51 and older by Medicaid status. The data were drawn from the 2000-2001 Health and Retirement Study. Household spending was categorized into three broad types: basic living, health care, and discretionary. Older (aged 51 or older) poor households without Medicaid allocated about 72% of their total resources ($17,421, SE $783) to basic living needs. In comparison, those with Medicaid had scarcer total resources ($12,498, SE $423) and allocated 85% to basic living needs. Medication costs consumed the largest proportion of health care expenses for both types of poor households (Medicaid: $463, SE $67; non-Medicaid: $970, SE $102). After paying for basic living needs and health care costs, these families had, on average, only $16 left each week. Poor families have very few resources available for anything beyond basic living needs, even when they have Medicaid coverage. There is no great reservoir of discretionary funds to pay for increases in cost-sharing under Medicaid and Medicare Part D.

Background Studies carried out in the community enable researchers to understand access to medicines, affordability, and barriers to use from the consumer's point of view, and may stimulate the development of adequate medicines policies. The aim of the present article was to describe methodological and analytical aspects of quantitative studies on medicine utilization carried out at the household level. Methods Systematic review of original papers with data collected in studies in which the household was a sampling unit, published between 1995 and 2008. The electronic review was carried out in Medline/Pubmed, Scielo and Lilacs. The reference lists of the papers identified were examined, as well as other publications by their authors. Studies on the utilization of specific pharmacological groups, or those including only respondents with a given disease were excluded. Results Out of 4852 papers initially identified in the literature search, 61 fulfilled our inclusion criteria. Most studies were carried out in Europe and North America and used a cross-sectional approach. More than 80% used face-to-face interviews for data collection, and the most frequently used recall period for assessing medicine utilization was 14–15 days. In 59% of the studies, interviewers were trained to request the packaging of the medicines reported by the subjects; medical prescriptions were requested less frequently (15% of the studies). Conclusion These data will be useful for updating researchers on what methods their peers are currently using. Such information may help overcome challenges in the planning and analyses of future studies. Moreover, this publication may contribute to the improvement of the quality of medicine use data obtained in household surveys.

This editorial introduces a series of case studies that together highlight the use of health market interventions to improve access to medicines in low-and-middle income countries (LMICs). It underscores the added value of using a systems approach for a holistic understanding of how these interventions interact with the rest of the health system and the intended and unintended consequences that result. It goes on to summarize key findings from each of the studies and concludes with lessons for decision-makers on the design and implementation of market based interventions in LMIC health systems.

Objectives The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI) schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods We used three complementary data collection approaches: (1) analysis of WHO National Health Accounts (NHA) and available results from the World Health Survey (WHS); (2) review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3) structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7%) and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI in several countries (e.g. Rwanda, Lao PDR) and the potential of CHI to improve medicines access and use, systematic research is needed on medicine benefits and their performance, including the impacts of CHI on access to, affordability, and use of medicines at the household level.