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Pharmacoeconomics in Africa: needs, prospect and challenges. J Pharm Policy Pract 2021; 14:47. [PMID: 34059103 PMCID: PMC8166127 DOI: 10.1186/s40545-021-00328-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Africa as a continent has experienced a continuous increase in the cost of healthcare as its demands increase. With many of these African countries living below the poverty threshold, Africans continue to die from preventable and curable diseases. Population increases have led to an increase in demands for healthcare, which unfortunately have been met with inequitable distribution of drugs. Hence, the outcomes from healthcare interventions are frequently not maximized. These problems notably call for some economic principles and policies to guide medication selection, procurement, or donation for population prioritization or health insurance. Pharmacoeconomics drives efficient use of scarce or limited resources to maximize healthcare benefits and reduce costs. It also brings to play tools that rate therapy choice based on the quality of life added to the patient after a choice of intervention was made over an alternative. In this paper, we commented on the needs, prospect, and challenges of pharmacoeconomics in Africa.
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Vaccine storage and distribution between expanded program on immunization and medical store department in Tanzania: a cost-minimization analysis. Vaccine 2020; 38:8130-8135. [PMID: 33162205 DOI: 10.1016/j.vaccine.2020.10.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2016, the Tanzanian government shifted the vaccine supply chain responsibilities from the Medical Store Department (MSD) to the Expanded Program on Immunization (EPI) to reduce costs. However, cost estimates that informed the decision were based on invoice value of vaccines and related supplies, rather than a proper economic evaluation study. Therefore, this study aims to compare the actual storage and distribution costs of vaccines and related supplies between MSD to EPI. METHOD Micro-costing approach was used to estimate resource use at MSD and EPI for the year 2018. Data were collected through a review of documents, warehouse databases, and interviews with key staff at MSD and EPI. We included both capital and recurrent costs. Microsoft Excel® was used for analysis with input data from the UNICEF forecasting tool, WHOs vaccine volume and capacity estimation tool, diesel generator calculator, and supply chain service fee estimator version 1.02. RESULTS The total vaccine storage and distribution costs were estimated to be USD 1,996,286 at MSD and USD 543,648 at EPI. Distribution and program management costs represented 41% (USD 819,288) and 38% (USD 762,968) of the total costs at MSD, while storage and distribution costs represented 43% (USD 234,423) and 34% (USD 184,620) of the total costs at EPI, respectively. The cost drivers at MSD were fuel and transport (21%), receiving and dispatch (19%) and, program management personnel cost (14%), while at EPI were storage space (20%), program management personnel cost (18%) and fuel and transport (15%). CONCLUSION The storage and distribution of vaccines in Tanzania via the EPI reduced the vaccine supply chain cost to about 27% of the program costs at MSD.
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Babar ZUD, Ramzan S, El-Dahiyat F, Tachmazidis I, Adebisi A, Hasan SS. The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries. Front Pharmacol 2019; 10:1375. [PMID: 31824316 PMCID: PMC6880243 DOI: 10.3389/fphar.2019.01375] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices, and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries. Methods: Data on affordability, availability, and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organization/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal, and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of innovator brand (IB) and lowest priced generic (LPG) of diabetes medicines by WHO regional groupings and by country level. Results: Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-month’s supply of IB of insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p = 0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of insulin 100 IU/ml and metformin 500 mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively. Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
| | - Ilias Tachmazidis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Adeola Adebisi
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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Luz A, Santatiwongchai B, Pattanaphesaj J, Teerawattananon Y. Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries. Health Res Policy Syst 2018; 16:4. [PMID: 29402314 PMCID: PMC5800077 DOI: 10.1186/s12961-018-0280-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of economic evaluation in healthcare policies and decision-making, which is limited in low- and middle-income countries (LMICs), might be promoted through the improvement of the conduct and reporting of studies. Although the literature indicates that there are many issues affecting the conduct, reporting and use of this evidence, it is unclear which factors should be prioritised in finding solutions. This study aims to identify the top priority issues that impede the conduct, reporting and use of economic evaluation as well as potential solutions as an input for future research topics by the international Decision Support Initiative and other movements. Methods A survey on issues regarding the conduct, reporting and use of economic evaluation as well as on potential solutions was conducted using an online questionnaire among researchers who have experience in conducting economic evaluations in LMICs. The respondents were requested to consider the list of issues provided, rank the most important ones and propose solutions. A scoring system was applied to derive the ranking of difficulties according to researchers’ responses. Issues were grouped into technical and context-specific difficulties and analysed separately as a whole and by region. Results Researchers considered the lack of quality local clinical data, poor reporting and insufficient data to conduct the analysis from the chosen perspective as the most important technical difficulties. On the other hand, the non-integration of economic evaluations into decision-making was considered the most important context-specific issue. Finally, context-specific issues were considered the larger barrier to the use of economic evaluation. Conclusion The technical issues that were considered most important were closely linked with the lack of an appropriately functioning information system as well as the capacity to generate essential contextual information (e.g. data and locally relevant utility values), especially when the methodology is complex. To overcome this, simpler approaches to collect data that yields information of comparable quality to more rigorous methods should be developed. The international community can play a major role through research on methodologies feasible for LMIC settings as well as in building research capacity in countries. Context-specific issues, which were recognised as larger barriers, should be improved in parallel. Electronic supplementary material The online version of this article (10.1186/s12961-018-0280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alia Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand.
| | - Juntana Pattanaphesaj
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Health, Nonthaburi, Thailand
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Shimazawa R, Ikeda M. Approval status and evidence for WHO essential medicines for children in the United States, United Kingdom, and Japan: a cross-sectional study. J Pharm Policy Pract 2017; 10:4. [PMID: 28070339 PMCID: PMC5217454 DOI: 10.1186/s40545-016-0094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background The WHO Model List of Essential Medicines for Children (EMLc) covers medicines for globally high-burden diseases. Regulatory approval in high-income countries ensures evidence and dosage form but usually focuses on diseases common in those countries and not in low- and middle-income countries. Methods This cross-sectional study assessed supporting evidence for the 346 medicines in the 5th WHO EMLc and their approval data from the United States, United Kingdom, and Japan. Results Of the 346 EMLc medicines, 307 were approved in one or more of the three countries, 278 of which had supporting evidence of efficacy. The percentage of medicines approved in one or more of the three countries was lowest for antiparasitics (60%) whereas 100% for medicines for cancers and musculoskeletal and respiratory conditions were approved. Five of the 30 EMLc antineoplastics had no supporting paediatric evidence. Of the 39 EMLc medicines unapproved in all three countries, 26 were indicated for neglected infectious diseases (NIDs). Ten of the 26 had supporting paediatric evidence. Seventeen of the 39 unapproved medicines had no paediatric dosage form available, and all 17 were indicated for NIDs. Conclusions Most EMLc medicines for diseases common in the three countries had supporting evidence, which was closely associated with approval, whereas a substantial number of medicines for NIDs were unapproved in the three countries, regardless of whether they had supporting evidence. Because of the limited contribution to the EMLc from high income countries, appropriate incentive mechanisms for pharmaceutical companies are required to make paediatric development for NIDs feasible and effective. Electronic supplementary material The online version of this article (doi:10.1186/s40545-016-0094-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rumiko Shimazawa
- Department of Clinical Pharmacology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Masayuki Ikeda
- Department of Medical Informatics, Kagawa University Hospital, Miki-cho Ikenobe, Kagawa 761-0793 Japan
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Pitt C, Goodman C, Hanson K. Economic Evaluation in Global Perspective: A Bibliometric Analysis of the Recent Literature. HEALTH ECONOMICS 2016; 25 Suppl 1:9-28. [PMID: 26804359 PMCID: PMC5042080 DOI: 10.1002/hec.3305] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 05/02/2023]
Abstract
We present a bibliometric analysis of recently published full economic evaluations of health interventions and reflect critically on the implications of our findings for this growing field. We created a database drawing on 14 health, economic, and/or general literature databases for articles published between 1 January 2012 and 3 May 2014 and identified 2844 economic evaluations meeting our criteria. We present findings regarding the sensitivity, specificity, and added value of searches in the different databases. We examine the distribution of publications between countries, regions, and health areas studied and compare the relative volume of research with disease burden. We analyse authors' country and institutional affiliations, journals and journal type, language, and type of economic evaluation conducted. More than 1200 economic evaluations were published annually, of which 4% addressed low-income countries, 4% lower-middle-income countries, 14% upper-middle-income countries, and 83% high-income countries. Across country income levels, 53, 54, 86, and 100% of articles, respectively, included an author based in a country within the income level studied. Biomedical journals published 74% of economic evaluations. The volume of research across health areas correlates more closely with disease burden in high-income than in low-income and middle-income countries. Our findings provide an empirical basis for further study on methods, research prioritization, and capacity development in health economic evaluation.
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Affiliation(s)
- Catherine Pitt
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Catherine Goodman
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Kara Hanson
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
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Babigumira JB, Jenny AM, Bartlein R, Stergachis A, Garrison LP. Health technology assessment in low- and middle-income countries: a landscape assessment. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Health technology assessment (HTA) for a wide range of healthcare technologies is an essential component of well-functioning health systems. Knowledge of the use of HTA in low- and middle-income countries (LMICs) is limited.
Methods
We performed a survey of HTA in selected LMICs. We interviewed key stakeholders on the use, conduct and challenges of performing HTA in their countries. We performed mixed-methods analyses to identify, characterize and describe HTA and how it relates to gross domestic product and government effectiveness.
Key findings
Of the 19 countries selected for participation, stakeholders in 12 (63%) countries responded to the survey – Afghanistan, Bangladesh, Democratic Republic of Congo (DR Congo), Dominican Republic, Ethiopia, Jordan, Kenya, Namibia, Rwanda, South Africa, Swaziland and Vietnam. Eight countries surveyed have some form of informal HTA activity conducted by stakeholders including academia, industry, government and the World Health Organization. There is evidence of knowledge sharing with five countries using HTAs from their neighbouring countries or from more developed countries. We found no evidence of formal HTA performed through dedicated, independent bodies in the LMICs surveyed. There was some evidence that HTA was moderately related to GDP per capita and strongly related to degree of centralization (government effectiveness). Respondents identified resources, both financial and human, as challenges to conducting HTA.
Conclusions
Formal HTA appears to be non-existent or limited in the LMICs surveyed but some evidence of informal HTA exists. Efforts to formalize HTA and to use existing HTA evidence will improve the quality of regulatory, coverage, formulary and reimbursement decisions, and individual and public health.
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Affiliation(s)
- Joseph B Babigumira
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Alisa M Jenny
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Andy Stergachis
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Louis P Garrison
- Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA
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Santatiwongchai B, Chantarastapornchit V, Wilkinson T, Thiboonboon K, Rattanavipapong W, Walker DG, Chalkidou K, Teerawattananon Y. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development. PLoS One 2015; 10:e0123853. [PMID: 25950443 PMCID: PMC4423853 DOI: 10.1371/journal.pone.0123853] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1969] [Accepted: 07/20/1969] [Indexed: 11/18/2022] Open
Abstract
Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.
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Affiliation(s)
| | | | - Thomas Wilkinson
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
| | | | | | - Damian G Walker
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Kalipso Chalkidou
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
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Mori AT, Kaale EA, Ngalesoni F, Norheim OF, Robberstad B. The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania. PLoS One 2014; 9:e84824. [PMID: 24416293 PMCID: PMC3885598 DOI: 10.1371/journal.pone.0084824] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. METHODS This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. FINDINGS The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. CONCLUSIONS Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.
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Affiliation(s)
- Amani Thomas Mori
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eliangiringa Amos Kaale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frida Ngalesoni
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Ole Frithjof Norheim
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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