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
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
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DOI：
10.1016/s0140-6736(12)61732-2
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发表时间：
2012-12-01
期刊：
影响因子：
168.9
通讯作者：
Hanson, Kara
中科院分区：
文献类型：
--
作者：
Tougher, Sarah;Ye, Yazoume;Hanson, Kara
背景疟疾是世界范围内造成死亡的最大原因之一。对有需要的人来说，使用最有效的疟疾治疗方法仍然不够，人们对出现对这些治疗方法的抗药性感到关切。2010年，全球基金启动了负担得起的疟疾药物融资机制(AMFm)，这是一系列国家规模的试点方案，旨在增加获得和使用有质量保证的青蒿素联合疗法，并减少青蒿素单一疗法治疗疟疾的机会。AMFm涉及制造商价格谈判、对所购买的每种治疗的制造商价格进行补贴，以及支持干预措施，如宣传活动。我们介绍了在加纳、肯尼亚、马达加斯加、尼日尔、尼日利亚、乌干达和坦桑尼亚(包括桑给巴尔)提供补贴ACT 6-15个月后，AMFm对QAACT价格、可获得性和市场份额的影响的研究结果。方法我们对库存抗疟疾治疗的公共和私营部门网点进行了具有全国代表性的基线和终点调查。QAACT是根据全球基金的质量保证政策确定的。根据AMFm实施一年的特定成功基准评估可用性、价格和市场份额的变化。在除尼日尔和马达加斯加以外的所有试点中，QAACT的可用性(25.8-51.9个百分点)和市场份额(15.9-40.3个百分点)都有较大幅度的增长，这主要是由私营营利性部门的变化推动的。在6名飞行员中，私人营利性部门的QAACT每成人当量剂量的中位数价格大幅下降，从1.28美元到4.82美元不等。口服青蒿素单一疗法在尼日利亚和桑给巴尔的市场份额下降，这两个试点国家的市场份额基线为5%以上。口译补贴与支持性干预措施相结合，可以有效地迅速提高QAACT的可获得性、价格和市场份额，特别是在私营营利性部门。关于AMFm未来的决定还应考虑对脆弱人群的使用、获得疟疾诊断的机会和成本效益的影响。
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 avail ability, 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.