Price subsidies increase the use of private sector ACTs: evidence from a systematic review

Abstract

Background Although artemisinin combination therapies (ACTs) are the recommended first-line treatment for uncomplicated malaria in most endemic countries, they have been prohibitively expensive in the retail sector where many suspected malaria cases purchase treatment. ACT subsidies seek to stimulate consumer demand for the drugs over cheaper but often ineffective alternatives by reducing their prices. Recent evidence from eight regions implementing such subsidies suggests that they are generally successful in improving availability of the drugs and decreasing their retail prices, but it remains unclear whether these outcomes translate to improved use by patients with suspected malaria.Methods A systematic literature review was conducted to identify reports of experimental or programmatic ACT subsidies to assess the impact of subsidies on consumer use. Relationships between price, use and potential confounding factors were examined using logistic and repeated measures binomial regression models, and approximate magnitudes of associations were assessed with linear regression. In total, 40 studies, 14 peer-reviewed and 26 non-peer-reviewed, were eligible for inclusion in the analysis. The reviewed studies found a substantial increase in private sector ACT use following the introduction of a subsidy. Overall, each $1 decrease in price was linked to a 24 percentage point increase in the fraction of suspected malaria cases purchasing ACTs (R2 = 0.302). No significant differences were evident in this relationship when comparing the poorest and richest groups, rural vs urban populations or children vs adults.Conclusions These findings suggest that ACT price reductions can increase their use for suspected malaria, even within poorer, more remote populations that may be most at risk of malaria mortality. Whether a subsidy is appropriate will depend upon local context, including treatment-seeking behaviours and malaria prevalence. This review provides an initial foundation for policymakers to make evidence-based decisions regarding ACT price reductions to increase use of potentially life-saving drugs.

Challenges in Treatment for Fever among School-Age Children and Adults in Malawi

“…Several trials across Africa have found that subsidies on RDTs and ACTs substantially increase their purchase and appropriate use for antimalaria treatment in retail shops. [35][36][37][38][39][40] If age-related differences are more attributable to perceptions of malaria risks, informational campaigns would be needed to encourage the use of recommended care. This study did not disentangle the reasons for different treatment-seeking choices.…”

Budget Impact Analysis of Using Dihydroartemisinin–Piperaquine to Treat Uncomplicated Malaria in Children in Tanzania

“…A majority of these premises stock ACTs, following the implementation of the Affordable Medicines Facility-malaria (AMFm) program [ 38 ]. Considering that the major incentive of these premises is to maximize sales, we assume that 60–80 % of febrile children receive anti-malarial drugs [ 39 ], of which about 40–60 % are a recommended first-line drug [ 40 ]. To capture the complexity of care seeking, we assumed that half of the patients who fail to respond to treatments will choose to shift to the public health facilities and the rest will remain in the private sector.…”

Modeling Key Malaria Drugs' Impact on Global Health: A Reason to Invest in the Global Health Impact Index

“…Again this will require addressing different issues in different countries, but the index helps us see where we are succeeding in addressing the global burden of malaria, and where we are not, and creates an incentive to address relevant issues wherever they occur. [10][11][12][17][18][19]38,43,[45][46][47] CLOSING THE KNOWLEDGE GAP There are several ways the Global Health Impact malaria model might be refined, especially as better data become available, but one of the benefits of the model is to make clear the gaps in global malaria surveillance efforts. [48][49][50] It is important to move from data on efficacy from clinical trials to actual estimates of global effectiveness.…”

“…[48][49][50] It is important to move from data on efficacy from clinical trials to actual estimates of global effectiveness. 46 Moreover, there is reason to move beyond a model that only credits originator companies who hold, or have acquired, the patent for these drugs. There are inevitably partner firms and others that deserve credit for the drugs' impact.…”