Sources and Prices of Medicines for Children. Consultation on Priority Essential Medicines for Child Survival 6th-7th September, 2010 Copenhagen, Denmark 1
Sources and Prices of Selected Medicines for Children Continuation of collaborative work started in 1999 to find and disseminate information on sources and prices of medicines relevant for emerging programmes where this was lacking: HIV/AIDS (1999-2005) Malaria (2004-2006) Available in www.unicef.org/supply/ and www.who.int/medicines/publications/ 2
Sources and Prices of Selected Medicines for Children. First edition, Jan 2009 77 Medicines and their formulations, mostly selected from EMLc Under nutrition Content of Publication Indicative prices Manufacturers and contact info Registration info Chapter on Children s medicines Sources Open market survey UNICEF suppliers WHO suppliers Tuberculosis Malaria S&P 2008 Diarrhea Pneumonia Opportunistic Sepsis and Infections infection HIV/AIDS Further use of this information Proactive update of UNICEF Supply Catalogue Identification of new sources for those products for which limited suppliers found 3 The inclusion of products and/or manufacturers in the report does not necessarily constitute prequalification or endorsement of any sort by UNICEF or WHO.
Sources and Prices of Selected Medicines for Children 2 nd edition of the S&P of medicines for children Medicines to address undernutrition Medicines to control malaria Medicines to reduce diarrhoea burden Medicines to reduce pneumonia death Medicines to reduce sepsis and infection in newborn Medicines to reduce HIV/AIDS burden Medicines for opportunistic infections/palliative care Antituberculosis medicines Expansion to cover all EML for Children. Consultation with WHO and Interagency Coordination Committee (IPC) to review medicines covered 4
2 nd edition of S & P of selected medicines for children Including therapeutic food, dietary vitamin and mineral supplementation Coverage of medicines for the treatment of Diarrhoea HIV/AIDS Malaria Maternal and newborn care Nutrition incl. vitamin and mineral supplementation Opportunistic infections Pneumonia Tuberculosis NEW in 2010: Pain and palliative care Neglected tropical diseases Other causes (remaining items from EMLc) Key points in 2010: 240 drugs (up from 77) in 612 different paediatric formulations 114(up from 80) manufacturers included. 52% from Europe, 33% from Asia, 5% from Africa. No sources identified for 144 products, mainly those available from limited sources in developed markets Opportunity to advocate for increased access to medicines for children (general and specialized media coverage, reference in sources of information on access to medicines) 5
6 S & P 2010 Missing products
Zinc Sulfate Cotrimoxazole Paracetamol Amoxicillin S & P 2010 - Price comparison Dispersible tablets against the liquid formulation Tablet dispersible 250mg Powder for oral susp. 250mg/5 ml Tablet dispersible 100mg Oral liquid 100mg/4ml Tablet dispersible 100+20mg Oral suspension 200+40mg/5ml - 2,5ml Powder for oral susp. 200+40mg/5 ml - 2,5ml Tablet dispersible 20mg Oral liquid 10mg/5 ml - 10ml 0 0.01 0.02 0.03 0.04 0.05 0.06 US $ per dose 7
S & P: Amoxicillin and Cotrimoxazole PRODUCT (NR OF MANUFACTURERS) UNIT MIN MAX MEDIAN 25 PERC INFO (*) AMOXICILLIN (28) Capsule: 250mg 1 cap 0.014 0.260 0.018 0.015 16/11 Capsule: 500mg 1 cap 0.013 0.402 0.032 0.028 17/12 Pediatric suspension: 125mg/1.25ml 1 ml n.a. n.a. n.a. n.a. 0/0 Powder for oral suspension: 125mg/5 ml 1 ml 0.002 0.039 0.006 0.004 15/10 Powder for oral suspension: 250mg/5 ml 1 ml 0.002 0.058 0.008 0.006 14/10 Sachet: 3g 1 sachet n.a. n.a. n.a. n.a. 0/0 Tablet (dispersible): 250mg 1 tab 0.017 0.023 0.022 0.021 4/3 Tablet: 400mg 1 tab n.a. n.a. n.a. n.a. 0/0 SULFAMETHOXAZOLE + TRIMETHOPRIM / COTRIMOXAZOLE (36) Injection: 80mg + 16mg/ml 1 ml n.a. n.a. n.a. n.a. 0/0 Oral suspension: 200mg + 40mg /5ml 1 ml 0.004 0.050 0.007 0.005 7/5 Powder for oral suspension: 200mg + 40mg/5 ml 1 ml 0.005 0.862 0.011 0.006 6/5 Tablet (dispersible): 100mg + 20mg 1 tab 0.004 0.016 0.006 0.004 6/3 Tablet: 400mg + 80mg 1 tab 0.008 0.112 0.012 0.010 18/8 Tablet 800mg + 160mg 1 tab 0.016 0.193 0.022 0.020 13/6 8
S & P: Diarrhoea PRODUCT UNIT MIN MAX MEDIAN 25 PERC INFO (*) ORAL REHYDRATION SALTS Powder for reconstitution 200ml 1 sachet 0.850 0.850 0.850 0.850 1/1 Powder for reconstitution 500ml 1 sachet 0.100 1.000 0.293 0.196 3/3 Powder for reconstitution 1000ml 1 sachet 0.012 1.800 0.125 0.083 6/5 ZINC SULFATE Oral liquid 10 mg/ 5 ml 5 ml 0.021 0.021 0.021 0.021 1/1 Tablet 10mg (dispersable) 1 tab 0.008 0.019 0.010 0.009 3/2 Tablet 20mg (scored) 1 tab 0.011 0.060 0.020 0.018 4/3 9
How are CCM needs met? How to engage manufacturers to register and compete for specific markets? No product registered 7 in S&P 3 syrups (60&100ml) and 3 oral suspensions (100ml) 17 in S&P 13 products in blister (2x10, 10x10, 25x10, 100x10) and bulk (1000) 22 in S&P 10
How are CCM needs met? PARA PNEUMONIA OU INFECÇÃO AGUDA NO OUVIDO DAR: AMOXICILINA: 50 mg/kg/dia 3 vezes por dia durante 5 dias IDADE ou PESO COMPRIMIDO (250 mg) COMPRIMIDO (500 mg) XAROPE (250 mg/ 5 ml) 2-12 meses (4- <10 kg) 1/2 1/4 2.5 ml 1-5 anos (10-19 kg) 1 1/2 5 ml Illness Age/Weight Group Product Treatment Course 1 PRODUCT FITS ALL? NO Need for products with specific characteristics (dispersable, multi-scored, in appropriate package) that makes regulatory process, procurement, distribution and dispensing complicated Units per treatment course Pneumonia Pneumonia Pneumonia Pneumonia 2 months - 4 months ( < 6 kgs) 5 months - 12 months (6-9 kgs) 13 months - 30 months (9-13 kgs) 31 months - 5 years (13-18 kgs) Amoxicillin (250mg) scored tablets Amoxicillin (250mg) scored tablets Amoxicillin (250mg) scored tablets Amoxicillin (250mg) scored tablets 1/2 tablet 2x per day for 5 days 5 1 tablet 2x per day for 5 days 10 1 1/2 tablets 2x per day for 5 days 15 2 tablets 2x per day for 5 days 20 11
Better access to medicines for children: How can we improve information on sources and prices? Information on manufacturers and products can assist programmes to identify potential sources, but is insufficient to address challenges in selection of products and procurement - More information on product characteristics to guide selection for specific programmes? - Information on regulatory approvals? - Specific focus on selected products within the current list? We would welcome suggestions for improvement, including solutions for data management and dissemination of information. 12