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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
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