Evaluation of Price Variation and Affordability of the Commonly Prescribed Antibiotics in Private Pharmacies of Mazar-I-Sharif City, Afghanistan

الملخص

Access to affordable and reasonably priced antibiotics is a major public health concern in resource-limited countries like Afghanistan, where high drug prices contribute to significant out-of-pocket expenses and can compromise treatment adherence. This cross-sectional and descriptive study aimed to assess the price variation and affordability of 12 commonly prescribed antibiotics in 12 private pharmacies in Mazar-I-Sharif city, Afghanistan. The study found significant price discrepancies, with Cefixime 400mg tablets and Azithromycin 500mg tablets exhibiting the highest price ratios (7.86 and 8.0) and percentage price variations (685.71% and 700%), respectively. Several antibiotics, including Cefotaxime 500mg vial (18.67 days’ wages), Ceftriaxone 1g vial (8.40), Ampicillin 1 g vial (6.67), Gentamicin 80mg/2ml ampoule (4.08), Amikacin 500mg/2ml ampoule (3.73), and Co-amoxiclav 625mg tablet (1.63), were highly unaffordable, requiring the lowest-paid unskilled government employee (cleaner or security guard) to pay their multiple days’ wages for a full treatment course with these antibiotics. Median price ratios (MPRs) for Gentamicin ampoule, Ampicillin vial, Ciprofloxacin tablet, and Ceftriaxone vial were found to be higher than the international reference price and exceeded the WHO/HAI acceptable threshold (MPR ≤ 2.5) for private-sector prices. Imported antibiotics, primarily from India (38.16%) and Pakistan (31.05%), dominated the Afghanistan Pharmaceutical market. In conclusion, essential antibiotics remain largely unaffordable in Mazar-I-Sharif city, exacerbated by brand variation, reliance on imports, and cumulative supply-chain mark-ups. Therefore, urgent policy interventions such as strong price controls, using regressive markups, tax reductions or exemptions for essential antibiotics, the promotion of domestically-made and generic antibiotics with guaranteed quality, and increased supply-chain price transparency are required to improve essential antibiotic access and affordability.