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Retail Drug Market and the Prices of Antimalarial Medicines in Enugu Urban, Southeast Nigeria: Implications for Affordability and Access to Artemisinin-based Combination Therapy Ezenduka Charles 1 , Okonta Mathew 2 , Ekwunife Obinna 2.

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  1. Retail Drug Market and the Prices of Antimalarial Medicines in Enugu Urban, Southeast Nigeria: Implications for Affordability and Access to Artemisinin-based Combination TherapyEzenduka Charles1, Okonta Mathew2, Ekwunife Obinna2 Health Policy Research Group Department of Pharmacology & Therapeutics, College of Medicine, University of Nigeria Enugu Campus Department of Clinical Pharmacy & Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka.

  2. Outline • Introduction & Background • Research questions & objectives • Methodology & study designs • Data collections and analysis • Findings and discussions • Conclusions and recommendations

  3. Introduction and background • A supply side analysis of antimalarial market from the private sector • Private sector in Nigeria is still responsible for over 60% of healthcare provision • Retail market for drugs accounts for a greater proportion of malaria treatment in Nigeria [Onwujekwe et al. 2009] • Study analysed the private retail market to identify opportunities for policy to improve malaria control • Part of a research on the economics of antimalarial medicines in Nigeria

  4. Study questions & objectives • What are the relative availabilities of antimalarial medicines in the retail market in Nigeria? • At what prices are antimalarial medicines sold and what are the determinants of the final prices? • How affordable are the antimalarial drugs? • How do market characteristics impact on the prices and affordability of antimalarial drugs in Nigeria? • What is the role of government on the prices of antimalarial drugs?

  5. Methodology & study design • Economic framework of structure-conduct-performance was used to analyse the retail market, comprising pharmacies and PPMVs • Prices and availability were determined based on the WHO/HAI recommendations • 38 out of 351 retail outlets in the urban city were sampled stratified by type and location • 5 categories of antimalarials were selected for survey study based on reasonable criteria • Urban setting was selected to capture the private sector which is almost completely concentrated in the area

  6. Data collection and analysis • Quantitative and qualitative tools were used to collect data for the analysis • Qualitative interviews assessed providers behaviours and their determinants • Quantitative survey was used to determine availability and prices of selected drugs • Retail audit measured quantities of selected drugs sold, based on equivalent adult doses • MS. Excel and Stata were used to analyse data • Data were analysed by drug category outlet type

  7. Findings

  8. Table 1.Prices and availabilities of antimalarial drugs

  9. Findings & Discussions • There is a very wide range of antimalarial drugs in the retail market with average of 10 brands in each outlet (at least 7 categories) with ACTs having the widest range • SPs are the most popular antimalarial agents available in every outlet and their use is highest in PPMVs largely based on self medication and low cost • ACTs are closely the second most popular antimalarial drugs with highest use,(57%) among pharmacies; and the most prescribed antimalarial agents by healthcare professionals • The use of monotherapy AS, AQ and CQ is very significant with implication for malaria resistance and quality of treatment

  10. Findings & Discussions • There is a wide variation of the prices of antimalarial medicines, $0.13 - $8.17 (median price $1.63) • ACTs are the most expensive antimalarial group with a median price of $5.23 at a range of $1.8 - $7.52; about 7 x the price of SP • 3 to 5 days income will be required to treat a malaria case with an ACT in a country where over 50% live below $2 per day • The retail market is highly characterised by low concentration and high price competition limiting retail mark-up to about 20% of final price • Procurement cost contribute over 75% of final price with little or no government regulation making it a policy target for price reduction • Level of competition highly influenced by open market due to poor or lack of government control

  11. Conclusions & Recommendations • Retail market significantly impacts on the prices and affordability of antimalarial medicines in Nigeria, highly characterised by competition and poor regulation • Findings suggest SPs and ACTs as the dominant antimalarial agents but monotherapy with AS is very significant which may include combination with AQ in ACT • ACTs have become increasingly popular but limited in use by high costs making them unaffordable to majority of low income population who live below the poverty line • Results confirm that in many countries access to ACTs is limited by unaffordable prices in addition to limited information on their relative efficiency in malaria treatment

  12. Conclusions & Recommendations • More efforts are needed in making the ACTs the drugs of choice in the treatment of malaria in Nigeria • As the major driver of high cost under high competition, procurement is a key target for price reduction to enhance affordability of ACTs in the country. • Government subsidised provision of drugs through the CMS could be expanded to include the private sector providers through the PPP • Regular training and update of retail providers and enhanced public enlightenment are required to increase the knowledge and use of ACTs in the country

  13. Thank you all

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