Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial

Cohen, Jessica; Dupas, Pascaline; Schaner, Simone

doi:10.1257/aer.20130267

Cited by 154 publications

(186 citation statements)

References 32 publications

Supporting

Mentioning

180

Contrasting

Order By: Relevance

“…No ongoing studies were identified. Overall, four studies (five articles) fulfilled the review inclusion criteria (Cohen 2015; Kangwana 2011; Kangwana 2013; Talisuna 2012; Sabot 2009; Figure 3). …”

Section: Resultsmentioning

confidence: 99%

“…Two studies (three articles) were cluster-randomised trials (Cohen 2015; Kangwana 2011; Kangwana 2013). The remaining studies were non-randomised cluster trials (Sabot 2009; Talisuna 2012).…”

Section: Resultsmentioning

confidence: 99%

“…The remaining studies were non-randomised cluster trials (Sabot 2009; Talisuna 2012). The studies were conducted in rural districts in Kenya (Cohen 2015; Kangwana 2011; Kangwana 2013), Uganda (Talisuna 2012) and Tanzania (Sabot 2009). One trial enrolled children under five years of age (Kangwana 2011; Kangwana 2013); both adults and children were studied in the other trials.…”

Section: Resultsmentioning

confidence: 99%

“…ACT price subsidies were accompanied with supportive interventions (including retail outlet provider training and community awareness campaigns lasting less than a year) in all except one study (Cohen 2015). The subsidy level was 95% in two studies (Kangwana 2011; Kangwana 2013; Talisuna 2012), 80% to 92% in one study (Cohen 2015) and 90% in the remaining study (Sabot 2009).…”

Section: Resultsmentioning

confidence: 99%

“… 5 Cohen 2015: Compared to an access rate of 19 percent in the control group, subsidies of 80 percent or more increased the likelihood that a malaria-like illness is treated with an ACT by 16 to 23 percentage points (i.e. 85 to 118 percent increase).…”

Section: Summary Of Findings For the Main Comparison [Explanation]mentioning

confidence: 99%

See 4 more Smart Citations

Subsidising artemisinin-based combination therapy in the private retail sector

Opiyo

Yamey

Garner

2016

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Malaria causes ill health and death in Africa. Treating illness promptly with artemisinin‐based combination therapy (ACT) is likely to cure people and avoid the disease progressing to more severe forms and death. In many countries, ACT use remains low. Part of the problem is that most people seek treatment from the retail sector where ACTs are expensive; this expense is a barrier to their use. The Global Fund and other international organisations are subsidising the cost of ACTs for private retail providers to improve access to ACTs. The subsidy was initially organised through a stand‐alone initiative, called the Affordable Medicines Facility‐malaria (AMFm), but has since been integrated into the Global Fund core grant management and financial processes. Objectives To assess the effect of programmes that include ACT price subsidies for private retailers on ACT use, availability, price and market share. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1, The Cochrane Library , including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHost), EconLit (ProQuest), Global Health (OvidSP), Regional Indexes (Global Health Library, WHO), LILACS (Global Health Library, WHO), Science Citation Index and Social Sciences Citation Index (ISI Web of Science) and Health Management (ProQuest). All databases were searched February 2015, except for Health Management which was searched November 2013, without any date, language or publication status restrictions. We also searched the International Clinical Trials Registry Platform (ICTRP; WHO), ClinicalTrials.gov (NIH) and various grey literature sources. We also conducted a cited reference search for all included studies in ISI Web of Knowledge, checked references of identified articles and contacted authors to identify additional studies. Selection criteria Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted‐time‐series studies that compared the effects of ACT price subsidies for private retailers to no subsidies or alternative ACT financing mechanisms were eligible for inclusion. Two authors independently screened and selected studies for inclusion. Data collection and analysis Two review authors independently extracted data, assessed study risk of bias and confidence in effect estimates (certainty of evidence) using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Main results We included four trials (two cluster‐randomised trials reported in three articles and two non‐randomised cluster trials). Three trials assessed retail sector ACT subsidies combined with supportive interventions (retail outlet provider training, community awareness and mass me...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Summary Of Findings For the Main Comparison [Explanation]mentioning

confidence: 99%

See 3 more Smart Citations

Subsidising artemisinin-based combination therapy in the private retail sector

Opiyo

Yamey

Garner

2016

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

The Enduring Debate Over Cost Sharing for Essential Public Health Tools

Cohen

2019

JAMA Netw Open

View full text Add to dashboard Cite

In the translation of health technology innovations into actual public health, among the most consequential decisions to be made is what to charge the end user. Achieving sufficient coverage with essential tools to control diseases like HIV and malaria requires price subsidies, particularly in low-income countries. Subsidies are necessary because willingness to pay and ability to pay are both assumed to be low in these settings. Economic theory predicts that willingness to pay will be too low because individual demand for essential health tools will not take community benefits, or externalities, into account. Ability to pay is likely low because of poverty. Owing to their crucial role in attaining high levels of coverage, subsidies for preventive, diagnostic, and treatment technologies make up a substantial portion of donor funding for infectious disease control. 1 While the need for subsidies is clear, the appropriate level of subsidy is not clear, and is often chosen based on guesses and trial and error. Higher subsidies should increase coverage, with the greatest coverage occurring when the subsidy is 100% (ie, the product is free). However, higher subsidies can pose trade-offs with respect to targeting products to the highest-value users. 2 A concern about free distribution of health tools such as insecticide-treated nets to prevent malaria, water purification kits to prevent diarrheal disease, and HIV self-tests is that anyone will take these tools when they are free-including people who do not need them and will not use them. If people who value and need tools most are also the ones most willing to pay, then lower subsidy levels could be a cost-effective approach to allocating scarce resources. Arguments for cost sharing (ie, partial rather than full subsidies) are generally based on this reasoning. However, cost sharing can also screen out the poorest households, who have limited financial resources but need the product most.The optimal subsidy will depend on how sensitive people are to price and how successfully price functions as a targeting mechanism.Chang and coauthors 3 add strong evidence to the growing body of work suggesting that even small amounts of cost sharing for health products can have substantial effects on uptake in low-income countries. 2,4 Chang et al 3 used a randomized trial to evaluate the impact of various distribution strategies-including variation in pricing, distribution point, and messaging-on demand for rapid HIV self-tests in Zimbabwe. Households were given vouchers that could be redeemed for a test, with randomly assigned prices between $0 (full subsidy

show abstract

Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe

et al. 2019

View full text Add to dashboard Cite

Key Points Question How is the demand for HIV self-testing influenced by pricing and distribution strategies? Findings In a randomized clinical trial of 4000 adults in Zimbabwe, demand for HIV self-testing declined substantially from 32.5% among those offered self-administered tests for free to 6.9% among those offered the tests for US $0.50 and below 3% at prices of US $1 or greater. Price sensitivity was higher among rural residents, men, and those who had never had an HIV test; in urban areas, demand was higher with pharmacy- than clinic-based distribution. Meaning This study suggests that demand for HIV self-testing is highly price sensitive in low-income settings; free distribution of self-tests may help promote their use in high-priority population segments.

show abstract

Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial

Cited by 154 publications

References 32 publications

Subsidising artemisinin-based combination therapy in the private retail sector

Subsidising artemisinin-based combination therapy in the private retail sector

The Enduring Debate Over Cost Sharing for Essential Public Health Tools

Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe

Contact Info

Product

Resources

About