Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data

Summary Background Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicine...

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Bibliographic Details
Published in:The Lancet (British edition) 2012-12, Vol.380 (9857), p.1916-1926
Main Authors: Tougher, Sarah, MDE, Ye, Yazoume, PhD, Amuasi, John H, MBchB, Kourgueni, Idrissa A, MSc, Thomson, Rebecca, MSc, Goodman, Catherine, PhD, Mann, Andrea G, PhD, Ren, Ruilin, PhD, Willey, Barbara A, PhD, Adegoke, Catherine A, PhD, Amin, Abdinasir, PhD, Ansong, Daniel, MBChB, Bruxvoort, Katia, MPH, Diallo, Diadier A, PhD, Diap, Graciela, MD, Festo, Charles, BSc, Johanes, Boniface, MHSM, Juma, Elizabeth, MMed, Kalolella, Admirabilis, MPH, Malam, Oumarou, BSc, Mberu, Blessing, PhD, Ndiaye, Salif, MSc, Nguah, Samuel B, MBChB, Seydou, Moctar, MSc, Taylor, Mark, PhD, Rueda, Sergio Torres, MSc, Wamukoya, Marilyn, MPH, Arnold, Fred, PhD, Hanson, Kara, SD
Format: Article
Language:English
Subjects:
adults
Africa
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials - economics
Antimalarials - standards
Antimalarials - supply & distribution
Antiparasitic agents
artemisinin
Artemisinins - economics
Artemisinins - standards
Artemisinins - supply & distribution
Biological and medical sciences
cost effectiveness
diagnostic techniques
Drug Costs
Drugs
General aspects
Human protozoal diseases
Humans
Infectious diseases
Internal Medicine
interviews
issues and policy
Lactones - economics
Lactones - standards
Lactones - supply & distribution
Malaria
Malaria - drug therapy
Malaria - economics
market share
Market shares
Marketing of Health Services
Medical sciences
Mortality
Parasitic diseases
Pharmacies - economics
Pharmacies - statistics & numerical data
Pharmacology. Drug treatments
Pilot Projects
Polls & surveys
Prices
private sector
Private Sector - economics
Profits
Protozoal diseases
Public health
Public sector
Public Sector - economics
quality control
Subsidies
surveys
tuberculosis
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Summary:Summary Background Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility—malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6–15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). Methods We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. Findings In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8–51·9 percentage points), and market share (15·9–40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. Interpretation Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. Funding The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(12)61732-2