Availability, cost, and affordability of asthma and chronic obstructive pulmonary disease medications in The Gambia

Objectives: Guidelines for asthma and chronic obstructive pulmonary disease (COPD) have undergone significant changes. Specifically, inhaled corticosteroids (ICSs) either alone or in combination with a long-acting beta2-agonist (LABA) are now first-line treatment for asthma, while long-acting muscarinic antagonists alone or in combination with LABAs are first-line treatment of COPD. Data on local availability, cost, and affordability of these medicines in The Gambia are unknown. Materials and Methods: We surveyed all registered pharmacists in Gambia and calculated affordability indices relative to the prevailing wage of the lowest government worker. Results: Eight out of 18 registered pharmacists responded to the survey. Respondents were responsible for stocking 19 out 26 registered pharmacies in the country, resulting in a response rate of 44%. Salbutamol inhalers were widely available, stocked by the central medical stores and 6 out of 8 surveyed pharmacists. Only one pharmacist reported stocking beclometasone 50 mcg, budesonide 100 mcg, and fluticasone propionate 125 mcg inhalers. Aminophylline was stocked by 4/8 pharmacists. The price of salbutamol 100 mcg inhaler was Gambian Dalasi (GMD) 200 (US$ 4, 4 days’ wages), while ipratropium bromide 20 mcg cost GMD 675 (US$ 14, 15 days’ wages). ICS maintenance inhalers at private pharmacies cost 15, 26, and 28 days’ wages for beclomethasone 50 mcg, fluticasone propionate 125 mcg, and budesonide 100 mcg, respectively. Combination of ICS/LABA inhaler was 26 days’ wages while tiotropium bromide 18 mcg affordability was 95 days’ wages. Conclusion: Guideline recommended medications for the management of asthma and COPD in The Gambia are unavailable, expensive, and unaffordable.