BACKGROUND. External reference pricing (ERP) is an internationally applied pricing policy to regulate the price of medicines. In 2005, the South African (SA) Minister of Health published a Government Gazette of regulations relating to a transparent pricing system for medicines and scheduled substances, stating that the Minister must publish a methodology for conforming to international benchmarks. In May 2014, the most recent proposed benchmark methodology was published, detailing that international benchmarking of medicines (IBM) requires that the lowest price in a selected basket of countries (Australia, Canada, New Zealand, Spain and SA) be used as the ultimate price for the purposes of benchmarking of originator products.OBJECTIVES. To provide a broad observational basis for the use of IBM and the proposed countries as a pricing tool; the feasibility of using BRICS countries (Brazil, Russia, India, China and SA) as comparator countries; and a small sample comparison of local state tender pricing in relation to the IBM proposed basket of comparator country pricing. Immunosuppressant medicines for organ transplant patients were used for this comparison, as they are relatively expensive and there is reluctance to implement pricing and reimbursement policy options to contain their costs.METHODS. Ex-manufacturer medicine pricing information for 2016, 2017 and 2018 was sourced for immunosuppressive medicines for SA (public and private sectors), Australia, New Zealand, Canada, Spain, Brazil and Russia. Unit prices were compared for products with the same international non-proprietary name (INN), strength, formulation and manufacturer. In most cases the products were matched on product name, bearing translation nuances in mind.RESULTS. Across all 3 years, in the majority of products, ERP using the proposed basket of comparator countries Australia, New Zealand, Canada and Spain lowered the local private sector ex-manufacturer price of medicine. Similarly, for the majority of products comparing local pricing with that of available BRICS country pricing data, the comparison lowered the price. For 92% of products where a comparison could be made, the SA state tender price was the lowest available price.CONCLUSIONS. Conducting an ERP analysis consumes time and resources. However, it may prove to reduce a current or proposed medicine price and may be considered as one of a range of medicine pricing policies employed by a country. It should not be used in isolation from other medicine pricing and reimbursement policies.

Introduction: ensuring the population's accessibility to a healthy diet requires addressing the conformation and monitoring of the value of a healthy food basket and the differential prices of foods following nutritional quality. Objectives: to design a healthy food basket (HFB) consistent with the recommendations given by Argentina's dietary guidelines (GAPA). The specific objectives were to define a nutritional quality index for foods and beverages, the composition of HFB by food group, assess values, and compare the prices and nutritional quality of foods available in local markets. Methods: the methodological framework was based on GAPA and the concept of nutritional density. To define the Nutritional Density Index (NDI) of food, 9 essential nutrients (proteins, fiber, calcium, iron, zinc, potassium, Vitamins A, C and B9), 3 critical nutrients (sugars, sodium and saturated fatty acids), the starch content, and the recommended intakes of the Institute of Medicine (IOM) were considered. Specifications were prepared on quantities, variety and qualities of food for the HFB, according to the food group. The prices were registered in shops in the City Centre (CABA) and neighboring municipalities of Buenos Aires. Results: when applying the NDI to a set of 320 foods and beverages consumed by the Argentine population, they were classified into three tertiles of quality. The resulting order is consistent with the recommendations of GAPA. The value of the HFB was $ 3759.- monthly (March 2018) for the reference unit of 2000 kcal. When comparing nutrient densities and food prices, starchy vegetables, eggs and legumes are the categories with the best nutritional quality / price ratio. The foods of better nutritional quality have a price of $ 14.- per 100 kcal and those of minimum quality $ 4.5.- Discussion: the HFB and NDI are tools to guide and evaluate policies that promote a better diet quality.

Introducción: asegurar la asequibilidad de la población a una alimentación saludable requiere abordar la conformación y el seguimiento del valor de una canasta saludable de alimentos y de los precios diferenciales de alimentos según calidad nutricional. Objetivos: diseñar una canasta saludable de alimentos (CSA) que resulte consistente con las Guías Alimentarias para la Población Argentina (GAPA). Los objetivos específicos son la definición de un índice de calidad nutricional de alimentos y bebidas, la conformación de la CSA por grupos de alimentos, su valoración económica, y comparar la calidad nutricional y los precios de alimentos disponibles en el mercado. Metodología: el marco metodológico se basó en las GAPA y el concepto de densidad nutricional. Para definir el Índice de densidad nutricional (IDN) de alimentos se consideraron 9 nutrientes esenciales (proteínas, fibra, calcio, hierro, zinc, potasio, Vitaminas A, C y B9), 3 nutrientes críticos (azúcares, sodio y ácidos grasos saturados), el contenido de almidón, y las ingestas recomendadas del Institute of Medicine (IOM). Se elaboraron especificaciones sobre cantidades, variedad y calidades de alimentos para la CSA según grupo de alimentos. Los precios fueron registrados en comercios de la Ciudad y partidos aledaños de Buenos Aires. Resultados: al aplicar el IDN a un conjunto de 320 alimentos y bebidas consumidos por la población argentina, se los clasificó en tres terciles de calidad. El ordenamiento resultante es consistente con las recomendaciones de las GAPA. El valor de la CSA fue de $ 3759.- mensuales (marzo 2018) para la unidad de referencia de 2000 kcal. Al comparar las densidades de nutrientes y precios de los alimentos, hortalizas feculentas, huevo y legumbres son las categorías con mejor relación calidad nutricional/precio. Los alimentos de mejor calidad nutricional tienen un precio de $ 14.- por 100 kcal y los de calidad mínima $ 4,5.- Discusión: la CSA y el IDN son herramientas para orientar y evaluar políticas que promuevan una mejor calidad de dieta.