asthma situation and the “asthma drug facility” response providing access to affordable quality...
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Asthma situation and the
“Asthma Drug Facility” response
Providing access to affordable quality assured essential asthma medicines
Global Burden of Asthma
• 300 million cases worldwide, still increasing• Common chronic disease among children• Majority in low- and lower-middle income countries• Prevalence higher in urban areas• Asthma accounts for about 1 death in every 250 deaths
worldwide• Health cost of asthma increases with ineffective
management
Masoli M et al.
Burden of asthma. http://www.ginasthma.com
Challenges for management of asthma in poor countries
• Major cause of unplanned visits to health facilities in urban centres
• Low income and low health expenditure per capita• Priority is given to communicable diseases• Poor access to health services, particularly for the
long-term management needed for asthma• Lack of trained health personnel • Low or non-affordability of asthma medicines for
patients
1. Improve affordability of essential asthma medicines in developing countries
2. Improve skills of health personnel by the development of a training package
3.Assess quality of care by regular monitoring and evaluation
The Union’s response
Ait-Khaled N et al. Allergy 2007;62:230-36.
Why create the Asthma Drug Facility?Low affordability of drugs in many countries
High cost (=low affordability for patients) of essential asthma drugs, particularly inhaled corticosteroids, has been demonstrated since 1998 in The Union studies:– Majority of patients cannot afford the
essential medicines.– Minority of rich patients are purchasing
very costly unnecessary medicines.
Why create an ADF?Low affordability
Cost for the patient of 1 inhaler in US$
% of countries
< $5 15
$5-9 11
$10-29 48
$30-55
Do not know
4
22
Survey (46 countries), The Union and ADF, 2005
e.g. Inhaled beclometasone 250µg
Why create an ADF?The health costs arguments
Low and middle-income countries cannot afford to not treat asthma
Costs increase when asthma not treated or incorrectly treated. We need to:
Reduce unnecessary expense of emergency visits, hospitalisation, and ineffective and inappropriate medicinesReduce indirect costs on
patients, families, governments
How does the ADF work?
• ADF organises qualification of manufacturers and products (as part of its Quality Assurance system), since asthma inhalers are not part of the WHO Prequalification Programme
• ADF establishes contracts with selected manufacturers for qualified products and proposes these products to countries, organisations, programmes
• Countries purchase generics at affordable prices
• ADF provides training materials and EpiData information system
Additional services in collaboration with The Union:
• Training courses and technical assistance
What do ADF clients need to do?
Clients must agree to:
• Use the products supplied according to the 4 step approach for treatment and diagnosis proposed in The Union Asthma guide
• A minimum order of 5000 corticosteroid inhalers• Take the responsibility for the importation of medicines into the
recipient country• Sell the medicines with a minimal mark-up or to provide them
free of charge to patients• Not re-export or resell these medicines• Make a full payment in advance to ADF• Submit quarterly monitoring reports to ADF
ADF Products*Recommended in WHO Essential Medicines List 2009
**Add to this: the costs of transport and insurance, preshipment inspection and 10% fees for ADF services (including quality control)
Product Primary Supplier(Country)
Price per unit FCA** (Euro)
Beclometasone 100µg/puff, 200 doses, HFA inhaler*
Beximco(Bangladesh)
1.07
Salbutamol 100 µg/dose, 200doses, HFA inhaler*
Beximco(Bangladesh)
0.83
Budesonide 200µg/puff, 200 doses, HFA inhaler*
Cipla/Medispray(India)
2.69
Fluticasone 125µg/puff, 120 doses, HFA inhaler
Cipla/Goa (India)
3.23
What else needs to happen for improvedaccess to quality asthma care?
• Commitment from respiratory specialists, public health specialists, health workers, communities
• Convince governments tobuy essential medicines for the majority of patients
• Country adoption / adaptation of international asthma guidelines
Contact
Asthma Drug Facility
International Union Against Tuberculosis and Lung Disease (The Union)
68, Boulevard Saint-Michel
75006 Paris, France
Tel: (+33) 1 44 32 03 75
Fax: (+33) 1 43 29 90 87
Website: www.GlobalADF.org (in English, French and Spanish)