Presentation (CTI)

OBJECTIVES: Transparency and equity are increasingly recognised as important pharmaceutical policy objectives. Although several assessment frameworks have been proposed, no harmonised approach exists for consistent cross-country measurement and comparison. This scoping review mapped how these concepts are conceptualised and measured, and explored challenges affecting feasibility and comparability.
METHODS: Searches of Web of Science, MEDLINE, Scopus, and EconLit were supplemented by grey literature and citation searching. Sources published between 2010 and 2025 were screened against predefined eligibility criteria by two researchers. Data were extracted on definitions, indicators, measurement approaches, and implementation challenges.
RESULTS: Out of 3612, 110 full text publications were included (106 peer-reviewed; 4 grey literature). Most focused on equity (n=84), compared with transparency (n=18), while 7 addressed both concepts. Among empirical equity studies (n=62), usage (57%), affordability (34%), and availability (26%) were the most frequently assessed dimensions, whereas acceptability was rarely measured (5%). Most studies assessed a single dimension of equity (61%), with only 10% evaluating three or more dimensions. Common indicators included treatment uptake, medicine availability, reimbursement coverage, out-of-pocket payments, and time to treatment or reimbursement. Among empirical transparency studies (n=11), governance and regulatory transparency was the most frequently assessed domain (82%), followed by pricing transparency (55%). Methods included logistic and multivariable regression models, concentration indices, descriptive comparative analyses, transparency checklists, and qualitative thematic analyses. Common limitations included incomplete public data, limited access to net prices, inconsistent reporting standards, reliance on proxy measures, and difficulties in cross-country comparison.
CONCLUSIONS: Current measurement approaches capture important aspects of transparency and equity but remain fragmented, limiting cross-country comparison and comprehensive assessment of pharmaceutical systems. The identified indicators and measurement domains provide a foundation for developing integrated frameworks and, ultimately, an internationally comparable index to support benchmarking, monitoring, and policy evaluation.