lessons learned from the global fund’s price and quality reporting (pqr) database t patrick...
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![Page 1: Lessons learned from the Global Fund’s Price and Quality Reporting (PQR) database T Patrick Aylward, Sophie Logez, Thuy Huong Ha, Monika Zweygarth, Carmen](https://reader035.vdocuments.net/reader035/viewer/2022062722/56649f345503460f94c51cea/html5/thumbnails/1.jpg)
Lessons learned from the Global Fund’s Price and Quality Reporting (PQR) database
T Patrick Aylward, Sophie Logez, Thuy Huong Ha, Monika Zweygarth, Carmen Perez Casas, Luca Li Bassi
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Major Topics
• Key Challenge: Data Quality
• Overview of the dataset
• Price Benchmarking at the Global Fund
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Why is this important?
• Pharmaceutical and Health Products ~ 40% of expenditure.
• Increasing emphasis on value for money
Health Products and Health Equipment; 19.8%
Medicines and Pharmaceut-ical Products; 19.0%
Human Resources; 14.4%Training; 10.2%
Infrastructure and Other Equipment; 8.7%
Living Support to Clients/Target Population; 5.1%
Planning and Administration; 5.2%
Monitoring and Evaluation; 4.1%
Communication Materials; 4.4%
Procurement and Supply Management Costs; 3.2%
Overheads; 2.8%
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What is Price and Quality Reporting?
• A web-based system for tracking the purchases of key pharmaceutical and health products
• Transactional data entered by Principal Recipients upon receipt of goods and verified by Local Fund Agents.
• PQR contains US$ 2.09 billion1 of procurement data from 119 countries from 2009 - 2011
1 Value of goods reported to the PQR as of 08 November 2011
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What is Price and Quality Reporting?
• Reporting is mandatory for six product categories:1. antiretrovirals,
2. antimalarial medicines,
3. anti-tuberculosis medicines,
4. bednets,
5. condoms,
6. rapid diagnostics tests for HIV and malaria
• All data is publicly available & updated every 24 hrs: http://www.theglobalfund.org/en/procurement/pqr/
• Data will be fed into the WHO Global Price Reporting Mechanism (~25% of data)
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Key Challenge: Data Quality• 700+ users in 119 countries reporting data
• High turnover and little training
• User interface wasn’t acceptable to our customers
• No dedicated resources to monitoring and governing data
• Low data quality that prevented system from being used as an operational tool
• In 2010, the Global Fund overhauled the system to improve data quality and usability of the system
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Key Challenge: Data Quality• Extreme outliers decreased substantially
• The new PQR meets or exceeds the expectations of 83% of in-country users
• 81% of PR respondents agreed with the statement “The PQR is a useful tool that helps me in my job.”
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The Dataset• US$ 2.09 billion1 of procurement data from 119 countries covering
procurement transactions
1 Value of goods reported to the PQR as of 08 November 2011
Category Cost (USD) %Total
Bednet $889 M 42.5%
Anti-Retroviral $776 M 37.1%
Anti-malaria medicine $142 M 6.8%
Anti-TB medicine $132 M 6.3%
Diagnostic test $117 M 5.6%
Condom $37 M 1.8%
Grand Total $2,093 M 100%
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The Dataset• Used to track trends, facilitate analysis and provide insight into
market dynamics
2007 2008 2009 2010 H1 2011
0
50
100
150
200
250
300
350
193
162
125104 100
Reported unit costs of common first line ARV Reg-imens
d4T+3TC+NVP (FDC)
d4T+3TC+EFV
AZT+3TC+NVP (FDC)
AZT+3TC+EFV
Basket of FL re-gimens
Vo
lum
e W
eig
hte
d M
edia
n
(US
$ p
er p
atie
nt
per
yea
r)
2008 2009 2010 20110
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
0.00
1.00
2.00
3.00
4.00
5.00
6.004.94
4.63 4.45 4.39
Quantity
Weighted Median Cost
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The Dataset• Used to track trends, facilitate analysis and provide insight into
market dynamics
Adult ARVs delivered to recipients in 2009 and 2010
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The Dataset• Encouraging recipients to compare prices against references and
other countries
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Price Benchmarking Global Fund Grants• 2010 ARV prices generally at or below international reference sources
Product Name StrengthMSF UTW: Lowest PQ
CHAI Ceiling
Median 75th Perc 90th Perc 2010 SalesNumber of Countries
Lamivudine + Nevirapine + Zidovudine - FDC 150mg+200mg+300mg $137 $140 $132 $135 $144 62,014,440$ 34
Lamivudine + Nevirapine + Stavudine - FDC 150mg+200mg+30mg $67 $79 $61 $64 $69 50,254,981$ 30
Lamivudine + Zidovudine - FDC 150mg+300mg $110 $110 $99 $103 $126 34,409,685$ 63
Efavirenz (EFV) 600mg $61 $75 $54 $62 $101 25,322,109$ 68
Lopinavir (LPV) + Ritonavir (RTV) - FDC 200mg+50mg $486 $440 $446 $468 $1,000 17,794,464$ 58
Emtricitabine + Tenofovir - FDC 200mg+300mg $143 $140 $139 $141 $141 12,734,522$ 27
Lamivudine + Tenofovir - FDC 300mg+300mg $107 $110 $108 $113 $132 9,960,938$ 13
Nevirapine (NVP) 200mg $34 $37 $32 $33 $39 7,179,176$ 53
Efavirenz + Emtricitabine + Tenofovir - FDC 600mg+200mg+300mg $219 $229 $242 $242 $242 4,506,762$ 9
Abacavir (ABC) 300mg $207 $222 $198 $219 $231 3,990,559$ 46
Tenofovir (TDF) 300mg $85 $87 $181 $226 $229 3,624,626$ 42
Lamivudine (3TC) 150mg $33 $32 $32 $43 $43 3,531,537$ 45
Lamivudine + Stavudine - FDC 150mg+30mg $42 $36 $39 $43 3,184,909$ 29
Efavirenz + Lamivudine + Tenofovir - FDC 600mg+300mg+300mg $200 $208 $208 $208 3,130,075$ 4
Zidovudine (AZT or ZDV) 300mg $91 $93 $82 $89 $98 2,725,196$ 41
PQR (Volume Weighted)
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Price Benchmarking Global Fund Grants
Source: PQR Downloaded 27 Sept 2011. South Africa data removed from analysis.-Médecins Sans Frontières. Untangling the Web of Antiretroviral Price Reductions. 13th ed. Campaign for Access to Essential Medicines; July 2010. Available from: http://utw.msfaccess.org/downloads/11
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Price Benchmarking Global Fund Grants
• Transactions benchmarked against range of historical international reference prices at the time of purchase order
• Two Key measures: Price Ratio & Cost Above/Below Reference
• Indicators can be aggregated to the product, recipient, grant, country level
• Price benchmarking a routine part of grant reviews
Condition Price Ratio Cost Above/Below Reference
Actual price < reference range
Actual price / lower bound of range
At least: US$: (Actual price – lower bound)*qty
Cost below reference
Actual price falls within reference range
1.0 US$ 0
Actual price > reference range
Actual price / upper bound of range
At least: US$: (Actual price – upper bound)*qty
Cost above reference
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Price Benchmarking Global Fund Grants
Example: Country A
Product Name Total Product Cost (USD)
Reference Price Ratio Cost above reference
Efavirenz (EFV) $ 6,510,468 0.77 -$ 1,951,134
Efavirenz + Lamivudine + Tenofovir - FDC $ 700,000 1.09 $ 58,124
Lamivudine (3TC) $ 289,926 0.87 -$ 44,827
Lamivudine + Nevirapine + Stavudine - FDC $ 13,755,718 0.82 -$ 2,947,680
Lamivudine + Nevirapine + Zidovudine - FDC $ 22,551,079 0.95 -$ 1,185,731
Lamivudine + Zidovudine - FDC $ 14,906,927 0.95 -$ 779,353
Nevirapine (NVP) $ 1,675,272 1.00 $ -
Stavudine (d4T) $ 423,500 0.91 -$ 40,513
Grand Total $ 60,812,890 0.89 -$ 6,891,115
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Next Steps
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Next Steps
• Better reports for PRs
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Next Steps
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Conclusions
• The PQR is a public good and is becoming a useful tool to procurement practitioners as well as researchers
• The PQR helps the Global Fund ensure value for money and has helped to bring transparency to the market
• The vast majority of ARVs procured in 2010 were purchased at prices either at or below international reference ranges or in line with originator tiered schemes
• Data challenges remain and users need to be cautious about context and comparing like to like
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QUESTIONS
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Key Challenge: Data Quality• Extreme outliers decreased from 15-20% of data points data points to
4-6% of data points,• The new PQR meets or exceeds the expectations of 83% of PR & LFA
respondents (up from 40%),• 81% of PR respondents agreed with the statement “The PQR is a
useful tool that helps me in my job.”
PQR Version 3.6 PQR Version 4.0
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Price Benchmarking Global Fund Grants
Source: PQR Downloaded 27 Sept 2011. South Africa data removed from analysis.-Management Sciences for Health. International Drug Price Indicator Guide (accessed 1 September 2011); July 2010. Available from: http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=english.