Availability, price and affordability of asthma medicines in five Indian states.

SETTING States of Haryana, Karnataka, Maharashtra and Rajasthan, and Chennai (capital of Tamil Nadu State), India. OBJECTIVE To assess the availability, price and affordability of beclomethasone and salbutamol inhalers in five Indian states using a standardised methodology. DESIGN Data on the availability and price of two essential medicines for asthma, beclomethasone (50 microg/dose) and salbutamol (0.1 mg/dose) inhalers, were collated from five medicine price studies on essential medicines. RESULTS Beclomethasone and salbutamol inhalers were available in 25% and 30% of public facilities in Rajasthan State only. The procurement price for beclomethasone and salbutamol was respectively 0.74 and 0.56 times the international reference price (IRP). The availability of beclomethasone inhalers was poor in the private sector (10-65%) in four states. The availability of salbutamol inhalers ranged from 20% to 95% as an innovator brand and 83% to 100% as the generic. The price of beclomethasone was 0.87-1.49 times the IRP, while salbutamol cost 0.82-1.12 times the IRP. Purchasing one inhaler each of salbutamol and beclomethasone cost between 1.6 and 2.3 days' wages for the lowest paid government worker. Eighty per cent of the population earn less than this wage. CONCLUSIONS Essential inhalation medicines for asthma were not available in the public sector where low-income populations receive treatment. Steroid inhalers were not readily available in the private sector. Essential inhalation medicines for asthma are not affordable for the majority of the population.