On 30 November 2009 Health Action International (HAI), a global NGO on pharmaceutical policy issues, undertook a global “snapshot” of the price of ciprofloxacin, a commonly used off-patent antibiotic. The prices of the originator brand product and the lowest priced generic equivalent were collected.

Data were collected from 93 countries globally (including 14 from the Eastern Mediterranean Region) where the price for a 7 day treatment course of ciprofloxacin ranged between US$ 0.42 and US$ 131. An interactive map on HAI’s website presents the results and shows large price differentials across the world for this medicine (see www.haiweb.org/medicineprices). While the prices should not be considered representative, as great price variation exists within some countries, these “snapshot” prices are indicative of what people have to pay, when paying the full retail price, in those pharmacies on that day.

The findings confirm that prices can vary widely both between countries and within countries. Although the patent on ciprofloxacin expired a number of years ago, the price difference between the lowest priced generic and the originator brand (the ‘brand premium’) is significant in many countries. For example, Colombia showed the largest brand premium, with the originator brand priced at 60 times the lowest priced generic. Colombia also had the highest treatment cost for originator brand ciprofloxacin in the private sector: a patient in Colombia pays more than 200 times the price they would pay in five Asian countries where the price of generics was lowest – a difference of almost 20 000%.

The WHO Regional office for the Eastern Mediterranean collaborated with HAI and through its network of WHO country offices and Ministries of Health. Official prices were collected in 14 countries (Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Libyan Arab Jamahiriya, Morocco, Pakistan, occupied Palestinian territory, Qatar, Somalia, Sudan, Syrian Arab Republic, United Arab Emirates, Yemen).

In the Eastern Mediterranean Region the average price for the originator brand (US$ 36.47) was twice the price in Southeast Asia (US$ 17.46) but less than in other regions. For lowest priced generics, the price in the Eastern Mediterranean Region (US$ 7.61) was more than in South-east Asian Region (U$ 1.19), African Region (U$ 4.55) and the Western Pacific Region (U$ 7.23).

In the Eastern Mediterranean Region the originator brand was 10.6 times the price of the lowest priced generic (similar to what was found in the WHO European Region). In other regions of the world, the price difference between originator and generic was even greater.

The average price of the originator brand shows very little variation across countries of different wealth. In contrast, the average price of generics decreased as the wealth of the country decreased. The use of low priced generic medicines is a significant step towards improving access to treatment. Generic ciprofloxacin is mostly available at a much lower price than the originator brand product, and in many cases, there is ample room to reduce the generic price further, making treatment more affordable.

“Governments need to further examine access to affordable essential medicines in their country and give it the priority it deserves. Being sick is enough of a misfortune; obtaining needed medicines should never result in choices between impoverishment, going without treatment or buying only a partial course of treatment”, said Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean.

For more information, a detailed briefing note is downloadable at the following link (www.emro.who.int/emp)