The role of market intelligence in access to anti-malarial medicines: funding, procurement, and policy

Transcription

1 The role of market intelligence in access to anti-malarial medicines: funding, procurement, and policy Brenda Waning Boston University School of Medicine November 20, 2009 American Society of Tropical Medicine & Hygiene Meeting Washington DC, USA

2 Presentation Outline 1. Review history and current status of transparency in medicines procurement -focus on HIV/AIDS, tuberculosis, and malaria 2. List some challenges faced in global malaria treatment 3. Present Boston University (BU) analytic data set & preliminary results of analyses on anti-malarial medicine procurements 4. Discuss additional utility of market intelligence data 5. Provide summary and conclusion

3 1. History & current status of transparency in medicines procurement (1) Until recently, information asymmetry was the norm Producers and suppliers held intelligence on medicine quality & price; purchasers had very little information 2001 WHO Prequalification improved quality transparency Web posting of medicines that passed quality testing FDA followed with Tentative Approval Process and web posting 2002 Global Fund improved price transparency Mandatory reporting and web posting of all commodity purchases Price Reporting Mechanism, Price Quality Reporting Mechanism 2005 WHO followed with Global Price Reporting Mechanism Web posting of procurements from Global Fund and many others Unprecedented movement in transparency, but utilization of information not yet optimized

4 2. Challenges in Global Malaria Treatment Medicines used in malaria exist within a market framework competition is a key to access to quality, affordable products yet we know very little about markets and competition Massive investments in malaria Practically no analysis of money spent on public sector procurements or global market evolution Desire to get more value for money Need to measure impact of new initiatives (AMFm), pooled procurement, etc., on market structure and access Programmatic design and global strategy decisions have not made use of existing market intelligence

5 3. Creation of BU analytic data set Global Fund 1st Price Reporting Mechanism Global Fund 2nd Price Reporting Mechanism Country Global Fund New Price Quality Reporting Medicine Mechanism Strength, Dosage Form Quantity Price Manufacturer Purchaser Other Merged Global Fund/WHO Data Identify & remove duplicates; Clean variables; Code; Classify; Validate Add >100 additional variables Final BU Data Set WHO Global Price Reporting Mechanism FDA & WHO PQ CHAI Prices Differential Prices WHO Regimens Other Data Sources Country Demographics Disease Burden # Treated GF Disbursements Many others

6 Anti-Malarial Medicines Transactional Overview Dates Jan 2004 July 2009 # Transactions 1,111 Total Amount $US #215,065,448 # Countries 61 # Dosage Forms 67 # Manufacturers* 30 *only 8 manufacturers are WHO-Prequalified

7 Market Share by WHO Region (value) African EMRO 2.3% W Pacific 1.9% Africa 95% European Eastern Mediterranean Americas Western Pacific South-East Asia

8 Reported Market Value (USD) Anti-malarial medicines by drug type ACT market $62.2 million $50.6 million $44.7 million $46.3m $52.3m $70m ACT AQ AQ/SP Art. Der. CQ MQ 2005 $39.6 million $42.2m PQ Q 2004 SP 0 20,000,000 40,000,000 60,000,000 80,000,000 Value in USD

9 Manufacturer Market Share of ACTs (value among multiple donors) $62.2 million $50.6 million $44.7 million $37.7 million 0 20,000,000 40,000,000 60,000,000 80,000,000 Value in USD Activa Ajanta Beijing Holley-Cotec Cipla Dafra Guilin Ipca Novartis Sanofi-Aventis Sanofi-Synthelabo Strides

10 Manufacturer Market Share of any SP-containing medicine (value) Cipla, Ltd. Flamingo Pharmaceuticals, Ltd. Guilin Pharmaceutical Co., Ltd Hoffman La Roche Ipca Laboratories, Ltd. Medicamen Biotech, Ltd. 0 1,000,000 2,000,000 3,000,000 4,000,000 Value in USD Medreich, Ltd. Micro Labs, Ltd.

11 Quinine Purchases by Country Uganda Sudan Sao Tome and Principe Rwanda Philippines Niger Nicaragua Multi-country Americas (Andean Region) Mauritania Malawi Liberia Haiti Georgia Democratic Republic of the Congo Central African Republic Value in USD Only 14 countries and 1 multi-country region reported purchasing quinine; Quinine is drug of choice for severe malaria

12 Any SP-Containing Medicine Purchases by Country Togo Swaziland Sudan Somalia Rwanda Philippines Nigeria Niger Mozambique Liberia India Gabon Democratic Republic of Central African Republic Cameroon Afghanistan 0 1,500,000 3,000,000 4,500,000 Value in USD 35 countries list SP for treatment in pregnancy; 16 report purchase of SP

13 Drug Purchases are a Very Small % of GF Malaria Disbursements (plots are per country per round) 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000, Total GF Disbursement Total Drug Purchases Total GF Disbursements = $1.48 billion Total malaria purchases = $186.8 million

14 Illustrative Example of Potential Timeline Analyses* # Days Sig to 1st Disb Expected Delivery Actual Delivery *Date variables are PROBLEMATIC and need further cleaning

15 Potential Utility of Data Analytic Potential Market Impact and market changes Pricing strategy, quality, global policy/donor decisions Dispersion/Uptake of new products Country reaction to WHO guideline changes Health Outcomes Value for Money Country Potential Procurement efficiency, capacity building Awareness of new products, price changes, etc. Program Potential Link data to systems: budgets, proposals, reports, m&e, purchasing

16 Example with Antiretroviral Medicines: Large Scale Purchase Arrangements Multiple regression of 7,253 ARV purchases* -19 of 24 (79%) ARV dosage forms revealed no pricevolume association* Pooled procurement, SCMS, and UNITAID will change market structure 2 nd line ARV Market Share (volume) by purchaser tenofovir 300mg lopinavir 200mg / ritonavir 50mg lamivudine 300mg / tenofovir 300mg emtricitabine 200mg / tenofovir 300mg didanosine 400mg didanosine 250mg abacavir 300mg 0% 20% 40% 60% 80% 100% UNITAID SCMS Global Fund Other *Waning et al. Analysis of Global Strategies to Reduce Prices of Antiretroviral Medicines: Evidence from a Transactional Database. Bull World Health Organ 2009;87:

17 5. Summary and Conclusions Global Fund and WHO changed the landscape around transparency of medicine information on price and quality Data can be enhanced and used to: Identify, describe and quantify problems; Design interventions; Examine impacts of past policies & strategies to build an evidence base; Predict impact of new policies & Project future costs for donors Data can also empower country users if provided in a more user-friendly format Provide timely market intelligence to procurement staff; Allow benchmarking of performance; Guide countries in regimen selection; Facilitate demand forecasting Transparency has risks, too! Need higher level discussion on appropriate level of transparency

18 Thank you Acknowledgements United Kingdom Department of International Development (DFID) Medicines for Malaria Venture (MMV) Boston University research team