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COSTING AND AVAILABILITY OF DRUG THERAPY AND DIAGNOSTIC ASSAYS FOR CRYPTOCOCCAL INFECTION

COSTING AND AVAILABILITY OF DRUG THERAPY AND DIAGNOSTIC ASSAYS FOR CRYPTOCOCCAL INFECTION. Iman Wanis , Cushla Coffey, Shaffiq Essajee , and Philippa Easterbrook World Health Organization, HIV Department (ATC) Geneva, Switzerland July 2011. CRYPTOCOCCAL DRUGS AND DIAGNOSTICS.

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COSTING AND AVAILABILITY OF DRUG THERAPY AND DIAGNOSTIC ASSAYS FOR CRYPTOCOCCAL INFECTION

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  1. COSTING AND AVAILABILITY OF DRUG THERAPY AND DIAGNOSTIC ASSAYS FOR CRYPTOCOCCAL INFECTION ImanWanis, Cushla Coffey, ShaffiqEssajee, and Philippa Easterbrook World Health Organization, HIV Department (ATC) Geneva, Switzerland July 2011

  2. CRYPTOCOCCAL DRUGS AND DIAGNOSTICS

  3. Funding and Supply/Distributors for Drugs • UNITAID/CHAI • The Global Fund • PEPFAR • National Government • NGOs e.g. MSF • Self-pay

  4. Challenges in the use of supplied medicines • Orders were low • Stock went unused • Countries had difficulty predicting need • Countries were not able to track cases or monitor use • Lack of consistent country practice and the need for clear guidance

  5. UNITAID/CHAI Progress of the projects Performance of suppliers Achievement of key objectives * Source: A meeting with UNITAID/CHAI Pediatrics ARVs Project Coordinator

  6. Programmatic Experience in UNITAID/CHAI Pediatric Amphotericin Donation Programme • Underutilised, orders were low • Clinicians not well informed about programme (reports of unused or expiring stock in pharmacy) • Not clear whether drugs are used for children or adults • No standardisation of process e.g. • Tracking and monitoring of use • Liaison with clinics • Forecasting/product quantifications • Need for consistent country practice and guidance

  7. Data Sources for Drug Costs 1. International Drug Price Indicator Guide (IDPI) • Published by Management Sciences for Health (MSH) since 1986 • Annually updated • Prices from pharmaceutical suppliers, international development organizations, and government agencies 2. Global Price Reporting Mechanism (GPRM) http://www.who.int/hiv/amds/gprm/en/ • Web-based database launched by the AMDS in April 2005 • Reports of price quotes from pharmaceutical companies, and other sources. • Price monitoring tool • Prices of drugs purchased and supplied by various procuring agencies for different countries: CHAI, Mission Pharma, MSH, PFSCMS, UNDP, UNFPA, UNICEF, UNITAID 4. Telephone Country Survey: 8 HIV clinicians, 1 laboratory director, 1 clinical microbiologist, 1 pharmacist, NAP director and 1 Information Management advisor.

  8. Amphotericin B (ampho) + Fluconazole (fluc) Costs in Sub Saharan Africa (GPRM) Uganda (2009) $2.6/50mg ampho $0.7/200mg fluc Burundi (2009) $2.6/50mg ampho $0.07/200mg fluc Angola (2008) $12.31/50mg ampho $0.174/200mg fluc Malawi (2009) $2.48/50mg ampho $0.07/200mg fluc

  9. Comparison of Costs of Amphotericin B and Fluconazole in IDPI (2010) & GPRM (2006-2010) Databases & Field Data

  10. Flucytosine Cost estimates from World Wide Web resources

  11. Diagnostics Cost Estimates from the field LA= CRAG Latex Agglutination LFA= CRAG Lateral Flow Assay SCMS= Supply Chain Management System

  12. Cost estimates from Literature

  13. Data Limitations • GPRM • Data ranges from 2004 – 2010, so comparisons between countries difficult • Data from only a few manufacturers. • Comparisons between IDPI, GPRM unreliable because: • Multiple sources of data from manufacturers (GPRM), suppliers and buyers • Data from different years.

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