Affordability of essential medicines: A case study of fluoride toothpaste

Objective: To evaluate the affordability of essential medicines by examining the case of fluoride toothpaste. Dental caries remains the most common non-communicable disease worldwide and the use of fluoride toothpaste is a most effective public health measure to prevent it. Methods: Fluoride toothpaste consumer price data were obtained from a self-completion questionnaire from 48 countries. The cost of fluoride toothpaste in high-, middle- and low-income countries was compared and related to annual household expenditure as well as to days of work needed to purchase the average annual consumption per head. Results: Fluoride toothpaste is not equally affordable in high-, middle- and low-income countries. Results suggest that the poorer the country, the greater the financial burden of purchase particularly for the poorest 20% of the population. To purchase the annual average dosage (182.5g), costs only 0.03 days of household expenditure in the UK, compared to 9 days in Zambia, and represents from 0.02% to 4% in Zambia of annual household expenditure in Japan and Zambia, respectively. Conclusions: Significant inequities in the affordability of this essential medication indicate the necessity for action to make it more affordable. Various measures to improve affordability of fluoride toothpaste based on experiences from essential pharmaceuticals are proposed.