Development of an agent-based model to assess the impact of substandard and falsified anti-malarials: Uganda case study

Ozawa, Sachiko; Evans, Daniel R.; Higgins, Colleen R.; Laing, Sarah; Awor, Phyllis

doi:10.1186/s12936-018-2628-3

Cited by 20 publications

(43 citation statements)

References 49 publications

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“…Because data on substandard and falsified medicines, care-seeking, and costs for malaria in LMICs are limited, we performed extensive literature searches and analysis of the most recent quality data for our inputs. Epidemiological data and cost inputs were probabilistically ranged to account for uncertainty in outcomes [26]. In addition, our data analysis was limited by data availability across countries where combined indicators were only available for 51 to 63 countries.…”

Section: Discussionmentioning

confidence: 99%

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Importance of medicine quality in achieving universal health coverage

et al. 2020

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Objective To assess the importance of ensuring medicine quality in order to achieve universal health coverage (UHC). Methods We developed a systems map connecting medicines quality assurance systems with UHC goals to illustrate the ensuing impact of quality-assured medicines in the implementation of UHC. The association between UHC and medicine quality was further examined in the context of essential medicines in low-and middle-income countries (LMICs) by analyzing data on reported prevalence of substandard and falsified essential medicines and established indicators for UHC. Finally, we examined the health and economic savings of improving antimalarial quality in four countries in sub-Saharan Africa: the Democratic Republic of the Congo (DRC), Nigeria, Uganda, and Zambia. Findings A systems perspective demonstrates how quality assurance of medicines supports dimensions of UHC. Across 63 LMICs, the reported prevalence of substandard and falsified essential medicines was found to be negatively associated with both an indicator for coverage of essential services (p = 0.05) and with an indicator for government effectiveness (p = 0.04). We estimated that investing in improving the quality of antimalarials by 10% would

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Section: Discussionmentioning

confidence: 99%

“…disease [26][27][28]. With quality-assured medicines, beneficiaries may be cured of illness, and may even avert disability or death [26][27][28].…”

Section: Plos Onementioning

confidence: 99%

Importance of medicine quality in achieving universal health coverage

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“…A review of modelling studies show that poor-quality medicines can result in serious harm and large inefficiencies which can be pitfalls to UHC, as shown in Tables 1 and 3 [15,[17][18][19][20][21][22]. The estimated economic losess from SF anti-malarials alone constitute a significant portion of the national budget for impacted countries (Table 1).…”

Section: Poor-quality Medicines: Counting the Costmentioning

confidence: 99%

Tackling the blind spot of poor-quality medicines in Universal Health Coverage

Orubu¹,

Ching²,

Zaman³

et al. 2020

J of Pharm Policy and Pract

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Background: Universal Health Coverage (UHC) is challenged by the prevalence of poor-quality medicines, those that either do not meet required specifications (substandard) or are outrightly fraudulent (falsified), especially in Low-and Middle-Income Countries, LMICs. Whereas poor-quality medicines are a significant burden in these countries, medicine quality still remains a neglected component of UHC programs. This article describes key barriers to quality medicines and presents five select approaches leveraging the scale-up of UHC for medicine quality assurance. Main body: Barriers to medicine quality assurance, while numerous, are described in five key interrelated domains as: low political priority, weak regulatory systems capacity, poor access to accredited facilities and licensed outlets, medicine manufacturing and other supply-chain challenges, and lack of public awareness. Five select approaches for leveraging the scale-up of UHC for medicine quality assurance in LMICs are (1): political commitment (2) strengthening the capacity of regulatory authorities and investment in detection technologies as part of national security (3); licensing of medicines outlets and expanding pharmacovigilance (4); strengthening the supply-chain; and (5) public awareness and participation. Conclusions: Unchecked, poor-quality medicines can jeopardize UHC. National governments in LMICs need to prioritize medicine quality assurance through enforcing policies, regulatory strengthening and investments in technologies. Healthcare facilities and insurance schemes under UHC also play critical roles through incorporating medicine quality assurance into procurement practices and by promoting awareness among beneficiaries. Tackling medicine quality with a committed systems approach will enhance progress towards UHC implementation.

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“…The Substandard and Falsified Antimalarial Research Impact (SAFARI) model was developed to estimate the health and economic impact of substandard and falsified antimalarials among children under five by simulating population characteristics, malaria incidence, patient care-seeking, disease progression, treatment outcomes, and associated costs [19,20,22]. The SAFARI model is an agent-based model implemented in Python.…”

Section: Agent-based Model Simulationmentioning

confidence: 99%

“…Previous analyses across Sub-Saharan Africa found that deaths due to substandard and falsified antimalarials comprise between 3.8 and 8.9% of malaria deaths relating to cases seeking treatment [18]. Country level analyses have demonstrated that substandard and falsified antimalarials contribute substantially to the pediatric malaria burden in both Nigeria and Uganda [19,20]. While existing literature on antimalarials in Zambia emphasizes the cost-effectiveness of treating malaria with ACTs [21], to the best of our knowledge no study has yet examined the economic impact of substandard and falsified antimalarials in Zambia.…”

Section: Introductionmentioning

confidence: 99%

Impact of substandard and falsified antimalarials in Zambia: application of the SAFARI model

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Background: Many countries are striving to become malaria-free, but global reduction in case estimates has stagnated in recent years. Substandard and falsified medicines may contribute to this lack of progress. Zambia aims to eliminate their annual burden of 1.2 million pediatric malaria cases and 2500 child deaths due to malaria. We examined the health and economic impact of poor-quality antimalarials in Zambia. Methods: An agent-based model, Substandard and Falsified Antimalarial Research Impact (SAFARI), was modified and applied to Zambia. The model was developed to simulate population characteristics, malaria incidence, patient care-seeking, disease progression, treatment outcomes, and associated costs of malaria for children under age five. Zambia-specific demographic, epidemiological, and cost inputs were extracted from the literature. Simulations were run to estimate the health and economic impact of poor-quality antimalarials, the effect of potential artemisinin resistance, and six additional malaria focused policy interventions. Results: We simulated annual malaria cases among Zambian children under five. At baseline, we found 2610 deaths resulting in $141.5 million in annual economic burden of malaria. We estimated that elimination of substandard and falsified antimalarials would result in an 8.1% (n = 213) reduction in under-five deaths, prevent 937 hospitalizations, and realize $8.5 million in economic savings, annually. Potential artemisinin resistance could further increase deaths by 6.3% (n = 166) and cost an additional $9.7 million every year. Conclusions: Eliminating substandard and falsified antimalarials is an important step towards a malaria-free Zambia. Beyond the dissemination of insecticide-treated bed nets, indoor residual spraying, and other malaria control measures, attention must also be paid to assure the quality of antimalarial treatments.

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Development of an agent-based model to assess the impact of substandard and falsified anti-malarials: Uganda case study

Cited by 20 publications

References 49 publications

Importance of medicine quality in achieving universal health coverage

Importance of medicine quality in achieving universal health coverage

Tackling the blind spot of poor-quality medicines in Universal Health Coverage

Impact of substandard and falsified antimalarials in Zambia: application of the SAFARI model

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