PONE-D-21-15309

Availability, prices and affordability of essential medicines: a cross-sectional survey in Hanam province, Vietnam

PLOS ONE

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Please could you insert a line in the introduction to describe the utilization of public versus private sector in Vietnam as well as addressing reviewers comments.

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: Evaluation

Thanks for sharing this manuscript (Availability, prices and affordability of essential medicines: a cross-sectional survey in Hanam province, Vietnam), which contains interesting information. The authors raised very important issue (access to essential medicine) in the this work; however I have minor issues in three areas in the manuscript that need to be addressed before it is accepted for publication:

1. Introduction

In lines 66-67, you stated several studies on the matter has been conducted; so what makes your different and urgent (is that because previous woks were unpublished?) what does it mean “small-scale studies”? (Lines 67 and 68)

The introduction part does not introduce pharmaceutical delivery system of the Vietnam (Good to know here the current situation regarding healthcare in Vietnam, e.g. how is healthcare typically provided. What are the current co-payments for visiting a physician, e.g. 100%, 50%, etc., and what is this amount relative to the daily wage of the LPGW? What about medicines - are these 100% co-pay - some medicines are free for the public in the public sector and covered through insurance - what are these medicines and how are they chosen? ….do public hospitals and primary healthcare centers stock and dispense similar items? Are all drug outlets in private sectors drug stores and possess all types of EMs that public hospitals and primary healthcare centers can—if there is level of capacity of handling medicine?...), challenges to achieve this paper’s interest, reasons that trigger this work, and previous studies findings.

2. The method

Why was the Hanam chose over other potential sources in Vietnam?

How many districts are there in Hanam, and how are these six districts selected?

Are all the medicines included in this study expected to be equally available in hospitals, primary healthcare centers and drug stores due to legal restriction? If not, this may give wrong information about the availability of the medicines.

Since you are informing your study objective, how do you obtain/trace/ real patient price data on medicines especially from private sectors?

For patient prices, MPRs should be lower than 1.5 in the public sector, and lower than 2.5 in the private sector. (Lines 129-130) Is there an agreed cut-point?

The daily wages of the lowest-paid unskilled government worker in USD during data collection (lines 135-136)

Affordability limit/declaration cut-off this work?

3. Results

Table 1 has to list individual medicines included in this study. The authors search continent approach to incorporate first column [Mean availability (standard deviation - SD)] in their new table. Such modification will give more detailed information about availability than the general one.

Table 4. For price comparison, as the guideline, it is recommended to take medicines found at least four of drug outlets in each sites from both sectors. In current work OBs are absent in the public sector, no need to use them. The remaining LPGs found in both sectors has to be listed individually and their MPRs (Min, 25th %, median, 75th % and Max) included. Focus your comparative discussion on these drugs only. If possible, try to merge, Table 5 in to Table 4. Figures that will be listed in the revised Table 1 may show the rest.

Table 5 would particularly benefit if it is changed into Figure for better general analysis. Using your reference #13 patient price cut-off point, you can point out patient prices of selected medicine. There are now standard graphics (available from HAI) in which both availability and affordability are combined in one graph. The x-axis shows availability (ranging from 0-100%, with a vertical line at 80%. The y-axis shows the affordability, with a horizontal line at the chosen cut-off point. In this graph all products have a point-position. In an ideal world all products are located in the right-lower corner of the graph, with availability at >80% and affordability below cut-off. The graph can clearly visualize where the problems are.

Table 6 would particularly benefit from an extensive review. In column 2, Drug name, strength, dosage form, dose, route of administration, frequency & treatment duration, Colum 3, Treatment schedule, The total amount of drug required to cover the complete treatment regimen, Column 4, Average drug Price per Unit (USD), and Column 5, Number of day’s wage to pay for treatment. In addition, sate reasons/description why bisoprolol 5 mg cap/tab and captopril 25 mg cap/tab used for hypertension management. This briefly shows how Vietnam STG (standard treatment guideline) looks like and how closer/far to/from IPRs (cost wise).

(See these references for Figure https://doi.org/10.1186/s12889-021-10745-5 and https://doi:10.1371/journal.pone.0070836)

Reviewer #2: Thank you for the opportunity to review this scholarly manuscript. The erudite disposition of the authors is commendable.

The paper has claimed that the availability of OBs was significantly low in both public and private sectors. Generic medicines were the predominant product type available in both public and private sectors. The mean availability of LPGs was fairly high but still lower than the benchmark of WHO. The prices of OBs were high and were unaffordable in private drug stores. LPGs in both sectors were sold to patients at reasonable prices compared to International retail prices.

These claims are properly placed in the context of available literature and the literature were fairly treated. Also, the data and analysis fully support the claim. A few minor remarks were noted. These would require the authors’ attention.

Abstract

- Result (line 33): insert the exact p value.

Introduction

Line 50: Insert reference.

Line 66: ………There are several studies on medicine prices, availability and affordability conducted in Vietnam [11, 12]. Some small scale studies were carried out but not published……….

What then is the gap in knowledge that this current study aimed to fill? Does this suggest that these studies were not on Essential medicines

Materials and methods

Lines 86/87: ………A licensed private drugstore closest to each of the selected public facilities was selected for the private sector………

The WHO/HAI methodology also provides for survey of 'Other' pharmacies which include those domiciled in private/organization owned hospitals. Does the province have these categories of hospitals? if yes, why were they not included in the survey? if no, a brief description of the health facility set up in Hanam would suffice.

Line 90: write ‘30’ in words

Results:

Table 3: Urban (11 drug stores) versus rural (24 drug stores) comparison

Does this suggest that most of the districts surveyed were in the rural area? A brief sentence regarding the geography of these areas should be added in the methods section

S1 Table

It is suggested that these medicines be group according to their class of drug. For example: Antibiotics, Psychotropic, Narcotics, Anti-inflammatory, Analgesics, Asthma medicines, Antihypertensive, Antidaibetic etc

Discussion

Line 215: …….fairly high (public sector 63.2%, private sector 47.9%)……….

Recast to reflect that availability of LPGs in private sector was fairly high but that in public sector was low (47.9%)

Line 283: Vietnamese government has implemented many national policies to increase the availability reduce medicine prices

The authors should stress the need for the enforcement of the price regulation in the private sector. Despite that fact that prices are generally lower than those of other countries, the private sector still sells OBs higher than the LPGs to the tune of 351.34%. Unless the LPGs are of reasonable quality and efficacy in treatment of the particular disease. Are there concerns for substandard medicines in Hanam?

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Reviewer #1: Yes: Habtamu Abuye Lambore

Reviewer #2: No

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Submitted filename: Reviewers Comments for the editor.docx

Availability, prices and affordability of essential medicines: a cross-sectional survey in Hanam province, Vietnam

PONE-D-21-15309R1

Dear Dr. Dinh,

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