Prices and mark-ups on antimalarials : evidence from nationally representative studies in six malaria-endemic countries

Palafox, Benjamin and Patouillard, Edith and Tougher, Sarah and Goodman, Catherine and Hanson, Kara and Kleinschmidt, Immo and Torres Rueda, Sergio and Kiefer, Sabine and O'Connell, Kate and Zinsou, Cyprien and Phok, Sochea and Akulayi, Louis and Arogundade, Ekundayo and Buyungo, Peter and Mpasela, Felton and Poyer, Stephen and Chavasse, Desmond. (2016) Prices and mark-ups on antimalarials : evidence from nationally representative studies in six malaria-endemic countries. Health Policy and Planning, 31 (2). pp. 148-160.

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Official URL: https://edoc.unibas.ch/62804/

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The private for-profit sector is an important source of treatment for malaria. However, private patients face high prices for the recommended treatment for uncomplicated malaria, artemisinin combination therapies (ACTs), which makes them more likely to receive cheaper, less effective non-artemisinin therapies (nATs). This study seeks to better understand consumer antimalarial prices by documenting and exploring the pricing behaviour of retailers and wholesalers. Using data collected in 2009-10, we present survey estimates of antimalarial retail prices, and wholesale- and retail-level price mark-ups from six countries (Benin, Cambodia, the Democratic Republic of Congo, Nigeria, Uganda and Zambia), along with qualitative findings on factors affecting pricing decisions. Retail prices were lowest for nATs, followed by ACTs and artemisinin monotherapies (AMTs). Retailers applied the highest percentage mark-ups on nATs (range: 40% in Nigeria to 100% in Cambodia and Zambia), whereas mark-ups on ACTs (range: 22% in Nigeria to 71% in Zambia) and AMTs (range: 22% in Nigeria to 50% in Uganda) were similar in magnitude, but lower than those applied to nATs. Wholesale mark-ups were generally lower than those at retail level, and were similar across antimalarial categories in most countries. When setting prices wholesalers and retailers commonly considered supplier prices, prevailing market prices, product availability, product characteristics and the costs related to transporting goods, staff salaries and maintaining a property. Price discounts were regularly used to encourage sales and were sometimes used by wholesalers to reward long-term customers. Pricing constraints existed only in Benin where wholesaler and retailer mark-ups are regulated; however, unlicensed drug vendors based in open-air markets did not adhere to the pricing regime. These findings indicate that mark-ups on antimalarials are reasonable. Therefore, improving ACT affordability would be most readily achieved by interventions that reduce commodity prices for retailers, such as ACT subsidies, pooled purchasing mechanisms and cost-effective strategies to increase the distribution coverage area of wholesalers.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Swiss Centre for International Health (SCIH) > Health Systems Support (Prytherch)
UniBasel Contributors:Kiefer, Sabine
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:London School of Hygiene and Tropical Medicine
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:02 Jul 2018 13:10
Deposited On:02 Jul 2018 13:10

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