OBJECTIVES: Cholinesterase inhibitors (ChEIs) have proved efficacy to treat dementia. However, their high costs post patient access problem in some countries. This study aims to explore the availability of ChEIs, and to compare power purchasing parity (PPP) of these medicines among selected countries with Thailand.

METHODS: Three middle-income and three high-income countries with online pricing information were selected. Donepezil 5 and 10 mg, rivastigmine patch 9.5 and 13.3 mg, and galantamine 8 and 16 mg which available in six countries were chosen. Price of branded and generic products were gathered. PPP ratio was calculated using Thailand as a reference country.

RESULTS: The study found that even all items were approved in India, Thailand, Malaysia, Japan, New Zealand, and Australia, only Australia approved all six ChEIs for reimbursement. Thailand had no item on the reimbursement list. All countries had generic items for donepezil, while none of them had generic rivastigmine 13.3 mg available. Australia was the only country that had generic for all ChEIs. The result on PPP ratio with Thailand as the reference country showed that Malaysia had the highest PPP ratios for three branded products, while Australia had the lowest PPP ratio for four branded products. Whereas Thailand had second highest PPP ratio for four branded products, Thailand had the largest different price between branded and generic products. Overall, Malaysia had the highest PPP ratio while New Zealand had the lowest PPP ratio. Among the studied countries, Australia and New Zealand were top two highest GDP per capita. However, both countries had PPP at 1.5 compared with USA in 2017 lower than Japan and India.

CONCLUSIONS: The study concluded that availability of generic was likely to have a great impact on reimbursement decision. Australia and New Zealand were countries with lowest PPP ratios for anti-dementia medicines.