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Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.
Lancet. 2012 Dec 01; 380(9857):1916-26.Lct

Abstract

BACKGROUND

Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar).

METHODS

We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process.

FINDINGS

In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline.

INTERPRETATION

Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness.

FUNDING

The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.

Authors+Show Affiliations

London School of Hygiene and Tropical Medicine, London, UK. sarah.tougher@lshtm.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23122217

Citation

Tougher, Sarah, et al. "Effect of the Affordable Medicines Facility--malaria (AMFm) On the Availability, Price, and Market Share of Quality-assured Artemisinin-based Combination Therapies in Seven Countries: a Before-and-after Analysis of Outlet Survey Data." Lancet (London, England), vol. 380, no. 9857, 2012, pp. 1916-26.
Tougher S, ACTwatch Group, Ye Y, et al. Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Lancet. 2012;380(9857):1916-26.
Tougher, S., Ye, Y., Amuasi, J. H., Kourgueni, I. A., Thomson, R., Goodman, C., Mann, A. G., Ren, R., Willey, B. A., Adegoke, C. A., Amin, A., Ansong, D., Bruxvoort, K., Diallo, D. A., Diap, G., Festo, C., Johanes, B., Juma, E., Kalolella, A., ... Hanson, K. (2012). Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. Lancet (London, England), 380(9857), 1916-26. https://doi.org/10.1016/S0140-6736(12)61732-2
Tougher S, et al. Effect of the Affordable Medicines Facility--malaria (AMFm) On the Availability, Price, and Market Share of Quality-assured Artemisinin-based Combination Therapies in Seven Countries: a Before-and-after Analysis of Outlet Survey Data. Lancet. 2012 Dec 1;380(9857):1916-26. PubMed PMID: 23122217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data. AU - Tougher,Sarah, AU - ,, AU - Ye,Yazoume, AU - Amuasi,John H, AU - Kourgueni,Idrissa A, AU - Thomson,Rebecca, AU - Goodman,Catherine, AU - Mann,Andrea G, AU - Ren,Ruilin, AU - Willey,Barbara A, AU - Adegoke,Catherine A, AU - Amin,Abdinasir, AU - Ansong,Daniel, AU - Bruxvoort,Katia, AU - Diallo,Diadier A, AU - Diap,Graciela, AU - Festo,Charles, AU - Johanes,Boniface, AU - Juma,Elizabeth, AU - Kalolella,Admirabilis, AU - Malam,Oumarou, AU - Mberu,Blessing, AU - Ndiaye,Salif, AU - Nguah,Samuel B, AU - Seydou,Moctar, AU - Taylor,Mark, AU - Rueda,Sergio Torres, AU - Wamukoya,Marilyn, AU - Arnold,Fred, AU - Hanson,Kara, Y1 - 2012/10/31/ PY - 2012/11/6/entrez PY - 2012/11/6/pubmed PY - 2012/12/18/medline SP - 1916 EP - 26 JF - Lancet (London, England) JO - Lancet VL - 380 IS - 9857 N2 - BACKGROUND: Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). METHODS: We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. FINDINGS: In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. INTERPRETATION: Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. FUNDING: The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/23122217/Effect_of_the_Affordable_Medicines_Facility__malaria__AMFm__on_the_availability_price_and_market_share_of_quality_assured_artemisinin_based_combination_therapies_in_seven_countries:_a_before_and_after_analysis_of_outlet_survey_data_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(12)61732-2 DB - PRIME DP - Unbound Medicine ER -