Costs and implications of asthma worldwide

Asthma Drug Facility – a practical solution

25 October 2011

Karen Bissell, Cécile Macé

Providing access to affordable quality assured essential asthma medicines

Asthma - Global Context

• Asthma is the most common chronic disease among children.

• Asthma affects millions of adults.

• 235 million people worldwide suffer from asthma.

• Asthma is a non-communicable disease (NCD).

• Asthma often goes undiagnosed, untreated or poorly treated.

• Effective medicines are available.

• Unfortunately, for many people with asthma – particularly the poor – these medicines are too costly or not available at all.

www.GlobalADF.org

Challenges and barriers for management of asthma in poor countries

• Prevalence of asthma increasing in urban areas• Asthma is a major cause of unplanned hospital visits• Countries prioritise communicable diseases, not NCDs• Lack of political will for asthma and commitment from

respiratory specialists, public health specialists, health workers

• Patients have poor access to health services. • Chronic diseases need long-term management. This is

often not available or well organised.• Lack of health personnel trained in asthma care

• Asthma medicines are mostly not affordable for patients or health services

• Funds often not allocated for purchasing essential medicines

• Evidence-based guidelines not available or not implemented

• Corticosteroids often not on the national Essential Medicines List (EML)

• Non-essential medicines pushed by pharmaceutical companies and specialist physicians

Challenges and barriers (2)for management of asthma in poor countries

Affordability of medicines

Since 1998, Union studies have shown the high cost of essential asthma medicines, particularly inhaled corticosteroids:

– Majority of patients cannot afford these medicines, listed as essential by WHO

Non-essential medicines are often available at very high cost

– Only a minority of very rich patients would be able to purchase these

Essential Medicines: Pricing, Availability and Affordability

The Union and The University of Auckland, NZ in ‘Global Asthma Report’ The Union, ISAAC, 2011

For countries and for patients, costs increase when asthma is not treated or incorrectly treated.

There are unnecessary expenses of emergency visits, hospitalisations, and ineffective and inappropriate medicines

Not treating asthma costs more than treating it properly

The Economic Burden of Asthma

Treating asthma entails vastly more than the cost of medicines. It amounts to billions of dollars in both direct and indirect costs.

© Sabir Nazar for The Union

• Improve affordability of essential asthma medicines in developing countries

• Improve skills of health personnel by the development of a training package

• Assess quality of care by regular monitoring and evaluation

The Union’s response

Ait-Khaled N et al. Allergy 2007;62:230-36.

A Practical Solution: Asthma Drug Facility (ADF)

• Provides affordable access to quality-assured, essential asthma medicines for low- and middle-income countries

• Promotes a quality improvement package for the diagnosis, treatment and management of asthma

How does the ADF work?

• Unlike TB and HIV essential medicines, asthma inhalers are not part of the WHO Prequalification Programme

• So, ADF organises “qualification” of manufacturers and products, using a Quality Assurance system based on WHO norms and standards.

• ADF establishes contracts with these selected manufacturers for qualified products and proposes these products to countries, organisations, programmes

• Countries purchase at affordable prices

• ADF provides training materials and an information system for following patient progress

Reduction in annual costs for a patient with severe asthma when medicines purchased

through ADF(in euros, based on 2009/2010 ADF prices)

7983

62

48

3540

0

10

20

30

40

50

60

70

80

90

BENIN SALVADOR SUDAN

In 2009, national procurement

In 2010, ADF procurement

ADF Product Prices for 2011Additional costs: transport, insurance, preshipment

inspection and 10% fees for ADF services

Product Primary Supplier(Country)

Price per unit FCA (USD)

Beclometasone 100µg/puff 200 doses, HFA inhaler*

Beximco(Bangladesh)

1.28

Salbutamol 100 µg/puff200 doses, HFA inhaler*

GSK Export(UK)

1.08

Budesonide 200µg/puff 200 doses, HFA inhaler*

Cipla/Medispray(India)

2.60

Fluticasone 125µg/puff120 doses, HFA inhaler

Cipla/Goa (India)

2.50

*On the 17th WHO Essential Medicines List March 2011

Financing solutions

Current options available for countries:

- The Global Fund: through the Practical Approach to Lung Health (PAL) component of TB grants

eg: Burundi, Guinea Conakry and Burkina Faso- Governmental budget line

eg: El Salvador- Other donors: budget line to purchase asthma

medicines (eg: Kenya, Vietnam) and sometimes to initiate a revolving fund (eg: Benin, Sudan)

Asthma appearing on the global health agenda

• UN High-Level Meeting on NCDs in September 2011

• PAL strategy implemented in around 50 countries (as part of Stop TB strategy)

• Funds made available for PAL activities by The Global Fund through TB applications

• Several publications mention the role of ADF

WHO Essential Medicines Monitor August 2011

NCD Alliance Briefing paper on Access to Essential Medicines for NCDs

Global Asthma Report 2011www.globalasthmareport.org(including preliminary results of a survey done on pricing, availability and affordability of essential asthma inhalers in 50 countries)

Contact

adf@theunion.org

www.globaladf.org