by Michael Woodhead
Essential paediatric medicines such as amoxicillin and salbutamol are often not available in Chinese hospitals or private sector pharmacies, and those that are stocked come with hefty markups, a survey from Shaanxi has found.
When researchers from Xi'an Jiaotong University surveyed a sample of pharmacies and hospital dispensaries to check the availability of 28 common paediatric medicines they found that less than 30% of the drugs on their list were available. The list included basic medicines such as antibiotics, analgesics, antihistamines and vitamins. Drugs that were not available included amoxycillin-clavulanic acid, ibuprofen, morphine and vitamin B6.
Writing in PLOS One, the researchers said this was a concern because when paediatric drugs are not available, doctors may try adapt adult versions of the drug by using lower doses, which is dangerous. Or if the recommended drug is not available, doctors may substitute a less appropriate drug, they added.
They also found that the paediatric drugs that were available often had huge markup over and above the manufacturers selling price. Amxoycillin, for example, had a manufacturer's price of 6.20 yuan but was sold to the patient for 11 yuan, a markup of 77%. Salbutamol had a manufacturer's list rice of 13 yuan but sold for 37 yuan to the public. The recommended treatment for chronic asthma, beclomethasone, cost about 1.6 days’ wages, which made it
unaffordable in the public sector hospitals especially as it is needed for ongoing
treatment of a chronic condition.
Most of the high markups was due to public hospital pharmacy profit margins.
The researchers concluded: "We recommend that relevant measures should be taken to enable children
to obtain sufficient medicines and effective treatment at affordable
prices. The government should adjust the prices of originator brands and
lowest-priced generics and improve the efficiency of centralised
medicine purchasing systems.
"We recommend urgently that the government should substantially improve
public drug procurement and price management, making the procurement
system more efficient and the pricing system more scientific, rational