Asthma Drug Facility. GARD Meeting Seoul, 2-3 June 2007 Dr Nils E. Billo

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1 Asthma Drug Facility GARD Meeting Seoul, 2-3 June 2007 Dr Nils E. Billo

2 Outline Why an Asthma Drug Facility for low- and middle-income countries? Drug procurement system Assuring quality of care Chances for success Challenges in countries

3 Why an Asthma Drug Facility? Burden, Health policy, Health services Majority of asthma and COPD cases live in developing countries. Numbers are increasing. Priority being given to communicable diseases by countries and by international community. Health services are not organised for long-term quality care of asthma or COPD. Health workers are not trained. Costs increase if patients not treated or incorrectly treated.

4 Why an Asthma Drug Facility? Low affordability of drugs High cost of essential asthma drugs, particularly inhaled corticosteroids has been demonstrated since 1998 in The Union studies e.g. 1 year of drugs for 1 case of moderate asthma can cost 4-6 months of nurse s salary Majority of patients cannot afford medication. Minority of rich patients are purchasing costly long-acting beta2, associations and antileucotrienes.

5 Why an Asthma Drug Facility? Inhaled beclomethasone 250µg, survey in 46 countries Cost for the patient of 1 inhaler in US$ % of countries < $5 15 $ $ $30-55 Do not know 4 22 The Union/ADF, 2005

6 Drug procurement system ADF structured: The Union technical team, 2 expert committees (SC and TRP), external technical advisors Selection of procurement agent: IAPSO Selection of manufacturer: Svizera Consultancy from expert pharmacists for ADF quality assurance Elaboration of documentation, procedures, ADF catalogue on UN Web Buy etc

7 Prices FCA prices in US$ for one inhaler (order of 10,000) Beclomethasone 250µg HFA: $1.43 CFC: $1.40 Salbutamol 100µg HFA: $1.05 CFC: $0.96 Budenoside 200µg HFA: $1.71 CFC: $1.62 Fluticasone 125µg HFA: $2.60 CFC: $2.51 Terbutaline 250µg HFA: $1.27 CFC: $1.17

8 Assuring quality of care The Union provides The Union Asthma Guide revised with the introduction of HFA drugs and new information system for monitoring Training materials: slides, participant and facilitator manuals Monitoring and evaluation: EpiData programme for registration and follow-up of patients

9 4 STEP APPROACH TO ASTHMA From concept to reality with HFA inhalers (CFC-free) Promote cost-effective regimen Diagnosis and treatment based on symptoms and lung function Extra-fine HFA-Beclomethasone 250 µg * Severe 4 puffs / day Moderate 2 puffs / day Mild 1 puff / day Intermittent 0 puff / day * And HFA-Salbutamol 100 µg as needed With The Union s technical package for asthma management

10 Assuring quality of care Clients role Organise training course and implementation of asthma management Register in EpiData all cases of persistent asthma Send ADF quarterly reports on case-finding and outcomes (automatically generated by EpiData Analysis) for evaluation of quality of care Find funds and request training courses and/or regular technical assistance

11 ADF - chances for success Competitive prices for essential asthma drugs with quality assurance Peak flow meter also available Technical package to guide implementation of asthma management Expansion of country demand: linked to the development of projects about asthma and COPD in many countries by all partners - PAL, GARD and The Union Increased awareness about CDR by WHO and partners could increase political involvement in countries Promotion and launch of ADF during World Asthma Meeting in June 2007

12 ADF - challenges in countries Obtain political commitment in countries to find budget for buying drugs through ADF Get specialists to convince governments to buy essential drugs for the majority of patients Promote private/public as complementary partners Adopt The Union approach standardised, costeffective care with evaluation

13 Contact Asthma Drug Facility (ADF) International Union Against Tuberculosis and Lung Disease (The Union) 68 boulevard Saint-Michel Paris, France Tel : (+33) Fax: (+33) ADF@iuatld.org Website in English, French, Spanish

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