Asthma and the Union's Asthma Drug Facility (Cecile Mace, Karen Bissell)

8/7/2019 Asthma and the Union's Asthma Drug Facility (Cecile Mace, Karen Bissell)

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Asthma situationand the

Asthma Drug Facility response

Providing access to affordable quality assured essential asthma medicines


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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

Number of DALYs lost 15 million/year

Asthma accounts for about 1 death in every 250 deaths

worldwide Health cost of asthma increases with ineffective

managementMasoli M et al.

Burden of asthma. http://www.ginasthma.com


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CKW Lai et all, Thorax.2008.106609


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Challenges and barriersfor management of asthma in poor countries

Prevalence of asthma increasing in urban areas

Major cause of unplanned visits to health facilitiesin urban centres

Low income and low health expenditure per capitaand priority is given to communicable diseases

Poor access to health services particularly forlong-term management

Lack of trained health personnel Low or non-affordability of asthma medicines for

patients


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Improve affordability of essential asthmamedicines in developing countries

Improve skills of health personnel by thedevelopment of a training package

Assess quality of care by regular monitoring andevaluation

The Unions response

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


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Why create the Asthma Drug Facility?Improve affordability

High cost (=low affordability forpatients) of essential asthmamedicines, particularly inhaled

corticosteroids, has been demonstratedsince 1998 in The Union studies:

Majority of patients cannot afford the

essential medicines Minority of rich patients are purchasingvery costly unnecessary medicines


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Why create an ADF?Low affordability

Cost for the patientof 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 250g


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Why create an ADF?The health costs arguments

Low and middle-income countriescannot afford to not treat asthma

Costs increase when asthma not treated orincorrectly treated. We need to:

Reduce unnecessary expense of emergencyvisits, hospitalisation, and ineffective and

inappropriate medicinesReduce indirect costs on

patients, families, governments


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How does the ADF work?

ADF organises qualification of manufacturers and products (aspart of its Quality Assurance system), since asthma inhalersare 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 informationsystem

Additional services in collaboration with The Union:

Training courses and technical assistance


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ADF Client Criteria

The client must agree to: 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

Use the products supplied according to international guidelinesfor diagnosis and treatment

Identify an individual responsible for providing monitoring reportsto the ADF

Submit routine monitoring reports, as specified in the TechnicalAgreement with the ADF


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ADF Products*Recommended in WHO Essential Medicines List 2010

**Add to this: the costs of transport and insurance, preshipment inspection and10% fees forADFservices (including quality control)

Product Primary Supplier (Country)

Price per unit FCA**(Euro)

Beclometasone 100g/puff,200 doses, HFA inhaler* Beximco(Bangladesh) 1.07

Salbutamol 100 g/dose,200doses, HFA inhaler*

Beximco(Bangladesh)

0.83

Budesonide 200g/puff,

200 doses, HFA inhaler*

Cipla/Medispray

(India)

2.69

Fluticasone 125g/puff,120 doses, HFA inhaler

Cipla/Goa(India)

3.23


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ADF Clients

Countries that have already received their orders

Pilot Projects in Benin (NTP), El Salvador (NTP),Sudan (Epi-Lab)

Kenya (KAPTLD) funded by World Lung Foundation

Current orders

Burundi (NTP) funded by Global Fund

Vietnam (CHRDI) funded by The Unions staff andboard fundraising

Potential clients

30 PAL countries receiving funds from Global Fund

Other contacts through asthma, TB, NCD networks


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Reduction in yearly cost for a case of severeasthma when purchasing through ADF

(in euros)

7983

48

35

0

1020

30

40

5060

70

80

90

BENIN EL SALVADOR

In 2009, throughnational procurement

In 2010, through ADFprocurement


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What else needs to happen for improvedaccess to quality asthma care?

Commitment from respiratory specialists, publichealth specialists, health workers, communities

Convince governments to

define an asthma strategyand buy essential medicines

for the majority of patients

Convince donors to finance

asthma medicines Country adoption / adaptation of international

asthma guidelines


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Contact

Asthma Drug Facility

International Union Against Tuberculosis andLung Disease (The Union)

68, Boulevard Saint-Michel

75006 Paris, France

Tel: (+33) 1 44 32 03 75

Fax: (+33) 1 43 29 90 87

[email protected]: www.GlobalADF.org (in English, Frenchand Spanish)


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Asthma Drug FacilityImproving the management of asthma patients

in low- and middle-income countries

Asthma and the Union's Asthma Drug Facility (Cecile Mace, Karen Bissell)

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