Subsidizing artemisinin-based combination therapies: a preliminary investigation of the Affordable Medicines Facility – malaria

Figures & data

Table 1 Average drug cost (in US dollars) and markup by formulation and presence of the Affordable Medicines Facility – malaria (AMFm) logo

Formulationa	Variable	Non-AMFm drugsb		AMFm ACTsc
		Adult	Child	Adult	Child
Artesunate-amodiaquine fixed-dose combination and co-blister	Overall average cost	$4.28	$3.29	$2.48	$1.64
	Overall average markupd	N/A	N/A	2.99	6.67
	Average cost in Lagose	N/A	N/A	$2.34	$1.60
	Average markup in Lagosf	N/A	N/A	3.06	8.33
	Average cost in Accrag	$4.28	$3.29	$2.80	$1.64
	Average markup in Accrah	N/A	N/A	2.83	6.25
Artemether-lumefantrine fixed-dose combination	Overall average cost	$4.40	N/A	$2.31	$2.01
	Overall average markup	N/A	N/A	2.82	6.98
	Average cost in Lagos	N/A	N/A	$2.45	$2.24
	Average markup in Lagos	N/A	N/A	3.20	3.89
	Average cost in Accra	$4.40	N/A	$2.02	$1.97
	Average markup in Accra	N/A	N/A	2.05	7.50
Dihydroartemisinin-piperaquine co-blister	Overall average cost	$3.29	N/A	N/A	N/A
	Average cost in Lagos	N/A	N/A	N/A	N/A
	Average cost in Accra	$3.29	N/A	N/A	N/A
Dihydroartemisinin monotherapy	Overall average cost	$2.50	N/A	N/A	N/A
	Average cost in Lagos	N/A	N/A	N/A	N/A
	Average cost in Accra	$2.50	N/A	N/A	N/A
Artesunate monotherapy	Overall average cost	$2.03	N/A	N/A	N/A
	Average cost in Lagos	$1.87	N/A	N/A	N/A
	Average cost in Accra	$3.62	N/A	N/A	N/A

Notes:

a Artesunate-amodiaquine fixed-dose combination and co-blister, artemether-lumefantrine fixed-dose combination, and dihydroartemisinin-piperaquine co-blister are ACTs;

b collected antimalarial drugs lacking an AMFm logo on packaging;

c collected antimalarial drugs displaying an AMFm logo on packaging;

d no markup data available for antimalarial drugs lacking an AMFm logo on packaging;

e cost based on conversion rate of USD 1 = NGN 156.5;

F markup based on expected price of NGN 120 per adult course and NGN 30 per child course (NGN 90 was used for the one child course of 18 pills per pack);

g cost based on conversion rate of USD 1 = GHS 1.52;

h markup based on expected price of GHS 1.5 per adult treatment and GHS 0.40 per child treatment.

Abbreviations: ACTs, artemisinin-based combination therapies; GHS, Ghanaian cedi; N/A, not applicable; NGN, Nigerian naira; USD, US dollars.

Table 2 High-performance liquid chromatography testing results (75%–125% active pharmaceutical ingredient [API] range) by formulation and presence of the Affordable Medicines Facility – malaria (AMFm) logo

Presence of logo	Artesunate-amodiaquine fixed-dose combination and co-blister [% (n)]	Artemether-lumefantrine fixed-dose combination [% (n)]	Dihydroartemisinin-piperaquine co-blister [% (n)]	Dihydroartemisinin monotherapy [% (n)]	Artesunate monotherapy [% (n)]	Total [% (n)]
Non-AMFm drugsa outside API range
Accra	75% (3/4)	7.7% (1/13)	100% (2/2)	0% (0/5)	100% (2/2)	30.8% (8/26)
Lagos	N/A	N/A	N/A	N/A	50% (10/20)	50% (10/20)
Total	75% (3/4)	7.7% (1/13)	100% (2/2)	0% (0/5)	54.5% (12/22)	39.1% (18/46)
AMFm ACTsb outside API range
Accra	58.3% (7/12)	0% (0/27)	N/A	N/A	N/A	17.9% (7/39)
Lagos	0% (0/11)	2.3% (1/44)	N/A	N/A	N/A	1.8% (1/55)
Lomé	0% (0/1)	0% (0/9)	N/A	N/A	N/A	0% (0/10)
Total	29.2% (7/24)	1.3% (1/80)	N/A	N/A	N/A	7.7% (8/104)

Notes:

a collected antimalarial drugs lacking an AMFm logo on packaging;

b collected antimalarial drugs displaying an AMFm logo on packaging.

Abbreviations: ACTs, artemisinin-based combination therapies; N/A, not applicable.

Table 3 Student’s t-test results by presence of the Affordable Medicines Facility – malaria (AMFm) logo

Presence of logo	Observed artemisinin mean (%)	SE	95% CI	t-value	DF
AMFm ACTsa	86.53558	0.9790648	84.59383–88.47732	−13.7523	103
Non-AMFm drugsb	75.29783	2.992279	69.2701–81.32459	−8.2553	45
Both AMFm and non-AMFm drugs combined	83.089	1.211986	80.69443–85.48423	−13.9529	149

Notes:

a collected antimalarial drugs displaying an AMFm logo on packaging;

b collected antimalarial drugs lacking an AMFm logo on packaging.

Abbreviations: ACTs, artemisinin-based combination therapies; CI, confidence interval; DF, degrees of freedom; SE, standard error.

Table 4 Shapiro-Wilk W test results by presence of the Affordable Medicines Facility – malaria (AMFm) logo

Presence of logo	W statistic	z statistic	Prob > z
AMFm ACTsa	0.96415	2.485	0.00647
Non-AMFm drugsb	0.74380	5.413	0.00000
Both AMFm and non-AMFm drugs combined	0.80925	7.028	0.00000

Notes:

a collected antimalarial drugs displaying an AMFm logo on packaging;

b collected antimalarial drugs lacking an AMFm logo on packaging.

Abbreviation: ACTs, artemisinin-based combination therapies.