ICIUM 2011 | 1 |

Inefficiencies Due to Poor Access to and Irrational Use of Medicines to Treat Acute

Respiratory Tract Infections in Children

Inefficiencies Due to Poor Access to and Irrational Use of Medicines to Treat Acute

Respiratory Tract Infections in Children

Dele Abegunde & Kathleen HollowayMedicines Access and Rational Use

ICIUM 2011 | 2 |

Background

Inefficiencies exist generally in all aspects of the health systems.

The extent of its attribution to poor access to appropriate treatment and irrational use of medicines is not well known.

Exploration of the level of inefficiencies will provide strong basis for evaluating the impact of interventions to improve access and rational use of medicines.

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ObjectivesObjectivesTo estimate and compare the cost of medicines for treating acute respiratory infections (ARI) in the under five year population accessing care under two comparator scenarios:

1. business-as-usual; and

2. treatment according to

recommended guidelines.

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MethodsMethodsIncidence based estimation of new cases in year 2010 (incremental cost)

Scenarios: business-as-usual compared with the counterfactual scenarios.

Bayesian algebra on data obtained from a number of sources including WHO, UNICEF,

Probability tree is constructed to estimate cost of medicines to treat ARIs in the under 5-year olds.

The counterfactual scenario assumes that new cases were provided with the appropriate medicines according to UNICEF/WHO recommended guidelines.

Cost per branch = (branch probability) X ((under5 population X incidence of ARI) X (Treatment coverage)) X (episode/annum) year 2010

Comparing these costs provides a rough indication of waste from inappropriate (ineffective) access to the appropriate medicines for treating ARI.

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MethodsMethodsSetting

A cross section of the under-5 population in 134: low-, lower middle-, upper middle - and high-income countries spanning 9 WHO sub regions, at risk of acute respiratory tract infection in year 2010.

Outcome Measure (s):

Acquisition cost of medicines consumed in international procurement prices and dollars (source MSH)

Excluding the freight-on-board (f.o.b), shipping, mark-ups, taxes and other additional (in-border) charges which are specific to countries.

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Treatment outcome possibility frontierTreatment outcome possibility frontier

A

XB

XC

X

D

X

E

X

F

X

Overkill: More cost combination to

achieve unattainable treatment

optimum given available inputs

Treatment outcome

possibility frontier:

Implicit in the

guidelines for treating

ARI

Under treatment: Sub-optimal out

put with associated input costing

Treatment output X

Trea

tmen

t out

put Y

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MethodsMethods

Acute Respiratory Tract Infection(ARI)

Treatment coverage

Treatment to Guidelines

Very sever

Moderately sever

URTI

Pneumonia

Treatment non Guidelines

Very sever

Moderately sever

URTI

Pneumonia

Very sever

Moderately sever

URTI

Pneumonia

Treatment coverage Treatment to Guidelines

Business as Usual Scenario

Counterfactual: everyone gets right treatment.

Figure 1: ARI treatment tree: Partitioned to business as usual and counterfactual scenarios Figure 1: ARI treatment tree: Partitioned to business as usual and counterfactual scenarios

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ResultsResults

$0

$2

$4

$6

$8

$10

$12

$14

SeverePneumonia

Moderatelysevere

pneumonia

Pneumonia URTI (commoncold)

Millio

ns

Effective access (Business-as-Usual) Poor access (Business-as-Usual)Total for Busness-as-usual Counterfactual (treatment to giudelines)

Figure 2: Comparing costs of medicines for treating ARIs for the business-as-usual and counterfactual scenarios Figure 2: Comparing costs of medicines for treating ARIs for the business-as-usual and counterfactual scenarios

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ResultsResultsFigure 3. Pattern of medicines use for the treatment of common cold in under-5 year olds.

Cough syrup4%

Antibiotics53%

Analgesics43%

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ResultsResults

Pneumonia

$0.0

$0.5

$1.0

$1.5

$2.0

Millio

ns

US

D

Upper respiratory tract infection

$0

$3

$6

29 20 26 6 12 4 1 7 7 22

AfrD AfrE AmrB AmrD EmrB EmrD EurB SearB SearD WprB

Millions

US

D

Effective treatment poor treatment Full access

Severe Pneumonia

$0

$1

$2

$3

Millio

ns

US

D

Moderately Severe Pneumonia

-$0.1

$0.2

$0.4

Millio

ns

US

D

Figure 4: Pattern of treating ARIs across regions

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Estimates of cost of medicines in the under 5sEstimates of cost of medicines in the under 5sCost of medicines to treat ARI in the under fives:

•business-as-usual scenario is aggregated to $21million

$4million is due to cost for the proportion of patients who could access appropriate and effective care while

$17million (81%) represents cost of medicines for those who had no access to proper care.

Over 80% of the cost of treating ARI in those who accessed care is spent on suboptimal and inefficient care.

•The estimated cost of the counterfactual (assuming full coverage to appropriate care): $16million.

When compared to the business as usual scenario, about $6million could be wasted on inappropriate care.

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Cost inefficienciesCost inefficiencies

Only 17.6% of the estimated cost of medicines for those who had access to care is due to appropriate and effective treatment.

This implies that over 80% of the cost of treatment is inefficiently applied to suboptimal treatments.

Total cost of medications giving current treatment (business-as-usual) scenario is 36% in excess of total cost of medicines that would be incurred if there was full access to appropriate treatment for those who accessed care.

Cost estimates for proportion of new cases which had access to effective and appropriate treatment in the current treatment (business-as-usual) scenario represent 24% of the total cost of medicines giving full access to appropriate medicines.

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SummarySummaryPattern of treatment and inefficiencies are similar for all WHO regions but magnitude is highest in the SEARO followed by WprB and the Afro Regions (figure 4)

Majority of the inappropriate treatment occur with the treatment of common cold.

Antibiotics cost 53% of the total cost of medicines used (figure 3). Antibiotics are not routinely recommended common cold in the standard WHO/UNICEF guidelines for treatment of ARIs in under-fives.

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ConclusionConclusion

The implication of these results is that inappropriate treatment of under-5 ARI results in excess cost of treatment ranging from 24% - 36% of the cost needed for appropriate treatment of ARI.

Efforts to motivate rational use and prescription of medicines in developing countries can potentially results into cost efficiencies and cost savings.

http:www.who.int/healthsystems/topics/financing/healthreport/BP52ARIFINAL.pdf

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Many thanks for listening