Subsidizing Artemisinin-Based Combination Therapies: A Preliminary Investigation of the Affordable Medicines Facility – Malaria

Research and Reports in Tropical Medicine, (3):63-68, 2012

6 Pages Posted: 30 Aug 2012 Last revised: 17 Oct 2013

See all articles by Roger Bate

Roger Bate

American Enterprise Institute (AEI)

Kimberly Hess

Africa Fighting Malaria (US)

Richard Tren

Africa Fighting Malaria (US)

Lorraine Mooney

Africa Fighting Malaria (UK)

Franklin Cudjoe

IMANI Center for Policy and Education

Thompson Ayodele

Initiative for Public Policy Analysis

Amir Attaran

University of Ottawa - Department of Epidemiology and Community Medicine; University of Ottawa - Common Law Section

Date Written: 2012

Abstract

Background: The Affordable Medicines Facility – malaria (AMFm) is a subsidy mechanism to lower the price of, and hence increase access to, the best antimalarial medicines, artemisinin-based combination therapies (ACTs). While the AMFm stipulates that only quality-approved products are eligible for subsidy, it is not known whether those products, when actually supplied, are of good quality and comport with established pharmacopeial guidance on formulation and content of active ingredients. This study aimed to assess price and quality of AMFm ACTs, to compare AMFm ACTs with non-AMFm ACTs and artemisinin monotherapies, and to assess whether AMFm ACTs have been pilfered and diverted to a nearby country.

Methods: In all, 140 artemisinin-based antimalarial drugs were acquired from 37 pharmacies in Lagos, Nigeria, and Accra, Ghana. An additional ten samples of AMFm ACTs were collected from Lomé, Togo (not participating in the AMFm). Samples were analyzed using high-performance liquid chromatography.

Results: The AMFm ACTs were lower in price than many of the other drugs collected, but by less than anticipated or stipulated by the participating governments of Nigeria and Ghana. The quality of the AMFm ACTs was not universally good: overall, 7.7% had too little active pharmaceutical ingredient (API) and none had too much – these results are not likely to be as a result of random chance. AMFm ACTs were also found to have been diverted, both to pharmacies in Lagos not participating in the AMFm and to a foreign city (Lomé) where the AMFm is not operational.

Conclusion: The AMFm is at best imperfectly displacing undesirable monotherapies, some portion of which are replaced by ACTs lacking sufficient API, which are often sold at prices exceeding government authorization. ACTs sold at a lower price with low-dose API, potentially extrapolated to approximately 100 million treatments ordered under the AMFm for Nigeria and Ghana, represent a possible concern to public health and the promotion of drug resistance.

Keywords: high-performance liquid chromatography, antimalarial drugs, active pharmaceutical ingredient, Ghana, Nigeria

Suggested Citation

Bate, Roger and Hess, Kimberly and Tren, Richard and Mooney, Lorraine and Cudjoe, Franklin and Ayodele, Thompson and Attaran, Amir, Subsidizing Artemisinin-Based Combination Therapies: A Preliminary Investigation of the Affordable Medicines Facility – Malaria (2012). Research and Reports in Tropical Medicine, (3):63-68, 2012, Available at SSRN: https://ssrn.com/abstract=2138442

Roger Bate

American Enterprise Institute (AEI) ( email )

1150 17th Street, N.W.
Washington, DC 20036
United States

Kimberly Hess

Africa Fighting Malaria (US) ( email )

Washington, DC
United States

Richard Tren

Africa Fighting Malaria (US) ( email )

Washington, DC
United States

Lorraine Mooney

Africa Fighting Malaria (UK) ( email )

Cambridge
United Kingdom

Franklin Cudjoe

IMANI Center for Policy and Education ( email )

14 Yeboa Street Chantan
Achimota
Ghana

Thompson Ayodele

Initiative for Public Policy Analysis ( email )

2 Olufunmilayo Street (Ground Floor)
Off CMD Road
Ikosi, Lagos
Nigeria

Amir Attaran (Contact Author)

University of Ottawa - Department of Epidemiology and Community Medicine ( email )

451 Smyth Road
Ottawa, Ontario K1H 8M5
Canada

University of Ottawa - Common Law Section ( email )

57 Louis Pasteur Street
Ottawa, K1N 6N5
Canada
613-562-5800 ext: 2015 (Phone)
613-562-5659 (Fax)

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