Doctoral Dissertation Research in Economics: Information frictions, demand for quality, and welfare in the market for antimalarials

经济学博士论文研究：抗疟药市场中的信息摩擦、质量需求和福利

• 批准号: 2117105
• 负责人: Dean Yang
• 金额: $ 2.5万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2117105&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Economics; Information

This award is funded in whole or in part under the American Rescue Plan Act of 2021 (Public Law 117-2). Malaria is extremely deadly: In 2019, 229 million cases worldwide caused 409,000 deaths; 23% of those deaths occurred in Nigeria. One key problem is the prevalence of substandard antimalarials: various studies find 11.8% (Beargie et al.) to 23% (WHO) of antimalarials sold do not have the correct active pharmaceutical ingredients percentage, typically meaning the pills are either counterfeits or were improperly stored. 35% of artemisinin-based combination therapies (ACTs) — the WHO's recommended treatment for uncomplicated malaria — were found to be substandard in a six-country study in sub-Saharan Africa (Bate et al.). Estimates indicate “poor-quality antimalarials are responsible for 12,300 deaths and $892 million ($890-$893 million) in costs annually in Nigeria” (Beargie et al.). In addition to ACTs, consumers have access to many less effective substitutes, including less effective drugs such as chloroquine and drugs not intended for the treatment of malaria. While a quarter of Nigerians mention ACTs when asked about malaria treatments they would use, 17% mention chloroquine, and 20% cite over-the-counter painkillers (aspirin, paracetamol, etc.) (DHS). Why are less effective treatments commonly used? In addition to a somewhat lower price point, consumers cannot be certain whether a drug they purchase is substandard and likely have difficulty assessing the relative effectiveness of different treatment options. Improving the functioning of markets for antimalarials can help affordable and effective, high-quality drugs reach those in need. This study seeks to improves our understanding of this vital market and highlight how consumer uncertainty about drug quality affects antimalarial choices. Beyond malaria, understanding how health product choices relate to perceptions of product quality could be valuable to policy makers trying to increase take-up of high-quality pharmaceuticals, such as Covid-19 vaccines: similar mechanisms will likely be at play, and counterfeit Covid-19 vaccines have been found in South Africa. Markets in low-income countries often fail to reliably provide high-quality versions of goods. Both theoretical and empirical work has highlighted the importance of information frictions in the low-quality equilibrium. This project will investigate information frictions in the antimalarials market. This market features quality uncertainty because i) highly effective drugs may be counterfeits or degraded, ii) myriad lower-quality alternatives exist, including weaker drugs and traditional remedies, and iii) learning about product quality is difficult, e.g. because antimalarials may be used to treat non-malaria fevers. The project asks four related questions about information frictions and the antimalarial market: how do information frictions influence demand for quality; what are the welfare consequences of information frictions, accounting for how beliefs about quality influence price, quality provision, and adoption in equilibrium; what are the distributional consequences of reducing information frictions; and how do information frictions influence the welfare effects and efficacy of common policies to increase uptake of high-quality antimalarials. To answer these questions, the project combines an RCT providing drug quality information (including free drug testing) to consumers with a structural model. The RCT allows for precise estimates of the effect of quality beliefs on demand for quality and evaluates a policy relevant intervention for improving uptake of high-quality antimalarials. The structural model, incorporating treatment effect estimates from the RCT, allows for counterfactual simulations of adoption choices and welfare under improved quality information. The model features both biased and noisy beliefs, advancing existing structural approaches, by using data on both beliefs about drug quality and true quality from test results.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

该奖项全部或部分根据2021年美国救援计划法案（公法117-2）资助。疟疾极其致命：2019年，全球有2.29亿例病例，造成409，000人死亡;其中23%的死亡发生在尼日利亚。一个关键问题是不合格抗疟药的流行：各种研究发现11.8%（Beargie等人）到23%（世卫组织）的抗疟药销售不具有正确的活性药物成分百分比，通常意味着药丸要么是假冒的，要么是储存不当。在撒哈拉以南非洲的一项六国研究中，35%的青蒿素联合疗法（ACTs）-世卫组织推荐的无并发症疟疾治疗-被发现不合格（Bate等人）。据估计，“在尼日利亚，质量差的抗疟药物每年造成12，300人死亡，并造成8.92亿美元（8.90 - 8.93亿美元）的费用”（Beargie等人）。除了青蒿素综合疗法外，消费者还可以获得许多效果较差的替代品，包括效果较差的药物，如氯喹和不打算用于治疗疟疾的药物。当被问及他们会使用的疟疾治疗方法时，四分之一的马拉维人提到ACT，17%的人提到氯喹，20%的人提到非处方止痛药（阿司匹林，扑热息痛等）。（DHS）。为什么常用的治疗方法效果较差？除了价格较低之外，消费者无法确定他们购买的药物是否不合格，并且可能难以评估不同治疗方案的相对有效性。改善抗疟药物市场的运作，可以帮助有需要的人获得负担得起的、有效的高质量药物。这项研究旨在提高我们对这一重要市场的理解，并强调消费者对药物质量的不确定性如何影响抗疟药物的选择。除了疟疾之外，了解健康产品选择与产品质量认知之间的关系，对于试图增加高质量药品（如新型冠状病毒疫苗）使用的政策制定者可能很有价值：类似的机制可能也在发挥作用，南非已经发现了假冒的新型冠状病毒疫苗。低收入国家的市场往往不能可靠地提供高质量的商品。理论和实证研究都强调了信息摩擦在低质量均衡中的重要性。该项目将调查抗疟药市场的信息摩擦。这一市场的特点是质量不确定，因为i）高效药物可能是假冒或降解的，ii）存在无数质量较低的替代品，包括较弱的药物和传统疗法，iii）了解产品质量很困难，例如因为抗疟药物可能用于治疗非疟疾发热。该项目提出了关于信息摩擦和抗疟药市场的四个相关问题：信息摩擦如何影响对质量的需求;信息摩擦的福利后果是什么，解释了关于质量的信念如何影响价格、质量提供和均衡采用;减少信息摩擦的分配后果是什么;以及信息摩擦如何影响提高高质量抗疟药物使用率的共同政策的福利效应和效力。为了回答这些问题，该项目将向消费者提供药物质量信息（包括免费药物测试）的RCT与结构模型相结合。随机对照试验允许精确估计质量信念对质量需求的影响，并评估改善高质量抗疟药物使用的政策相关干预措施。结构模型，纳入治疗效果估计的随机对照试验，允许反事实模拟的采用选择和福利下提高质量的信息。该模型的特点是既有偏见和噪音的信念，推进现有的结构性方法，通过使用两个信念对药物质量和真正的质量从测试结果的数据。这个奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估的支持。