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Impact of introducing subsidized combination treatment with artemether-lumefantrine on sales of anti-malarial monotherapies: a survey of private sector pharmacies in Huambo, Angola.
Trans R Soc Trop Med Hyg. 2016 12; 110(10):588-596.TR

Abstract

BACKGROUND

Artemisinin-based combination therapies (ACTs) against malaria are subsidized in many African countries, but the impact of subsidy programs in reducing the sales of concomitantly available antimalarial monotherapies is poorly defined.

METHODS

Data from The MENTOR initiative, that introduced subsidized artemether-lumefantrine (sAL) in the private sector of Huambo province, Angola, were used. The main response variable was represented by sales of sAL and of monotherapies, measured as number of treatment courses. Sales in private pharmacies of sAL and four antimalarial monotherapies between 2009 and 2013 were organized in four time-periods, and analyzed using generalized linear models for repeated measures. A secondary analysis evaluated changes in relative market share.

RESULTS

We analyzed data from 34 pharmacies at four time points, taken from a larger survey that involved 165 pharmacies between June 2009 and March 2013. The sAL, following its introduction, became the dominant antimalarial treatment in the private sector, usually exceeding the total sales of all antimalarial monotherapies combined (1480/2800 total treatment courses, 52.8% of all sales in March 2013). Sales of monotherapies decreased significantly, but did not stop, representing 36.7% (1028/2800) of sales at the end of the survey.

CONCLUSIONS

Subsidized ACTs can attain rapidly a high relative market share. Their introduction reduced, but did not eliminate the demand for less effective monotherapies, that might favor parasite resistance.

Authors+Show Affiliations

Population Services International, Luanda, Angola clussiana@psi.org.Istituto Superiore di Sanitá, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.The MENTOR Initiative, Huambo, Angola.National Malaria Control Programme, Ministry of Health, Luanda, Angola.The MENTOR Initiative, London, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27856948

Citation

Lussiana, Cristina, et al. "Impact of Introducing Subsidized Combination Treatment With Artemether-lumefantrine On Sales of Anti-malarial Monotherapies: a Survey of Private Sector Pharmacies in Huambo, Angola." Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 110, no. 10, 2016, pp. 588-596.
Lussiana C, Floridia M, Martinho do Rosário J, et al. Impact of introducing subsidized combination treatment with artemether-lumefantrine on sales of anti-malarial monotherapies: a survey of private sector pharmacies in Huambo, Angola. Trans R Soc Trop Med Hyg. 2016;110(10):588-596.
Lussiana, C., Floridia, M., Martinho do Rosário, J., Fortes, F., & Allan, R. (2016). Impact of introducing subsidized combination treatment with artemether-lumefantrine on sales of anti-malarial monotherapies: a survey of private sector pharmacies in Huambo, Angola. Transactions of the Royal Society of Tropical Medicine and Hygiene, 110(10), 588-596.
Lussiana C, et al. Impact of Introducing Subsidized Combination Treatment With Artemether-lumefantrine On Sales of Anti-malarial Monotherapies: a Survey of Private Sector Pharmacies in Huambo, Angola. Trans R Soc Trop Med Hyg. 2016;110(10):588-596. PubMed PMID: 27856948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of introducing subsidized combination treatment with artemether-lumefantrine on sales of anti-malarial monotherapies: a survey of private sector pharmacies in Huambo, Angola. AU - Lussiana,Cristina, AU - Floridia,Marco, AU - Martinho do Rosário,Joana, AU - Fortes,Filomeno, AU - Allan,Richard, Y1 - 2016/11/17/ PY - 2016/07/28/received PY - 2016/10/21/revised PY - 2016/10/25/accepted PY - 2016/11/20/pubmed PY - 2018/3/10/medline PY - 2016/11/19/entrez KW - Affordable Medicines Facility-malaria (AMFm) KW - Artemether-lumefantrine KW - Artemisinin KW - Malaria KW - Monotherapies SP - 588 EP - 596 JF - Transactions of the Royal Society of Tropical Medicine and Hygiene JO - Trans R Soc Trop Med Hyg VL - 110 IS - 10 N2 - BACKGROUND: Artemisinin-based combination therapies (ACTs) against malaria are subsidized in many African countries, but the impact of subsidy programs in reducing the sales of concomitantly available antimalarial monotherapies is poorly defined. METHODS: Data from The MENTOR initiative, that introduced subsidized artemether-lumefantrine (sAL) in the private sector of Huambo province, Angola, were used. The main response variable was represented by sales of sAL and of monotherapies, measured as number of treatment courses. Sales in private pharmacies of sAL and four antimalarial monotherapies between 2009 and 2013 were organized in four time-periods, and analyzed using generalized linear models for repeated measures. A secondary analysis evaluated changes in relative market share. RESULTS: We analyzed data from 34 pharmacies at four time points, taken from a larger survey that involved 165 pharmacies between June 2009 and March 2013. The sAL, following its introduction, became the dominant antimalarial treatment in the private sector, usually exceeding the total sales of all antimalarial monotherapies combined (1480/2800 total treatment courses, 52.8% of all sales in March 2013). Sales of monotherapies decreased significantly, but did not stop, representing 36.7% (1028/2800) of sales at the end of the survey. CONCLUSIONS: Subsidized ACTs can attain rapidly a high relative market share. Their introduction reduced, but did not eliminate the demand for less effective monotherapies, that might favor parasite resistance. SN - 1878-3503 UR - https://www.unboundmedicine.com/medline/citation/27856948/Impact_of_introducing_subsidized_combination_treatment_with_artemether_lumefantrine_on_sales_of_anti_malarial_monotherapies:_a_survey_of_private_sector_pharmacies_in_Huambo_Angola_ L2 - https://academic.oup.com/trstmh/article-lookup/doi/10.1093/trstmh/trw071 DB - PRIME DP - Unbound Medicine ER -