Academic journal article Bulletin of the World Health Organization

Pricing, Distribution, and Use of Antimalarial Drugs

Academic journal article Bulletin of the World Health Organization

Pricing, Distribution, and Use of Antimalarial Drugs

Article excerpt

Introduction

While much attention has been paid to the development of new antimalarial drugs, the development of the ability to deliver them to people at risk has lagged behind -- in large part because of economic considerations. In a typical drug supply system, decisions as to where, when, and what quantity of a drug are used are often influenced by price and affordability considerations more generally; this is true at household level as well as at national level.

The first part of this paper describes prices of antimalarial drugs and pricing policies for drugs for tropical diseases, including antimalarials. The second describes the various drug distribution systems found in developing countries with reference to the impact of price, and the third reviews the decisions made regarding the selection, distribution, and use of antimalarial drugs, in both public and private sectors, with reference to price and its influence on decisions about the use of antiamalarials at household level. While malaria continues to be a major health problem in many parts of the world, in sub-Saharan Africa the situation is especially severe, with an estimated 90 million clinical cases occurring annually--nearly 18 times more cases than in the rest of the world combined [1]. As a result, many of the examples presented are from Africa.

Countries where malaria is endemic present a wide variety of economic situations, ranging from Malawi and Bangladesh with incomes of US$ 170 per capita to Thailand with US$ 1000 per capita, and to Malaysia nd Brazil with around US$ 2000. Approximately 3000 million persons (over half the world's population) have annual per capita incomes of US$ 500 or less. Per capita income levels, however, can be a misleading guide to actual cash available to any given individual since income is unequally distributed. As an example, the poorest 20% in Brazil have only 2.4% of the national income, but the top 10% have nearly 50% [2]. On average, the richest 20% of the population has 12 times the income of the poorest 20%.

National expenditures on health and on pharmaceuticals are usually correlated with income as well; per capita drug consumption in developed countries averaged US$ 62 in 1985, but in developing countries the average expenditure was only US$ 5.40 [3]. Many sub-Saharan African countries are spending much less than US$ 5 annually per person on drugs. The economic situation influences malaria control, and in particular the use of antimalarial drugs at both national and individual level. What is affordable and feasible in one country may be completely beyond the means of another.

Prices and pricing policies

Antimalarial drugs can be classified into two categories as far as price is concerned. The first group is what might be termed "commodity generic" antimalarials, drugs that are traded in large quantities on the international market and whose patents have expired, e.g., chloroquine. The second is the group of relatively new antimalarials which are available from only one or a few sources; these are still under patent and therefore usually available only under brand names. Current (May 1990) unit prices for some common antimalarial drugs are presented in Table 1.

[TABULAR DATA OMITTED]

Prices of a single treatment (for an adult weighing approximately 65 kg) using various antimalarial drugs vary significantly (by a factor of nearly 66), from US$ 0.08 for chloroquine to US$ 5.31 for halofantrine, and nearly US$ 2.00 for mefloquine (Table 2). These prices effectively exclude the use of the newer drugs for all but a very few patients.

The breakdown of prices for bulk generic drugs is of interest. Raw materials account for about 70% of the price of a tablet of internationally traded bulk generic chloroquine. Bulk chloroquine phosphate has recently been trading on the international market for about US$ 30 per kg. Assuming 10% waste during formulation, a kg of chloroquine would yield about 6000 tablets of 150 mg base (or 9000 of 100 mg base); the active ingredient therefore costs about US$ 0. …

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