Amani Thomas Mori and Bjarne Robberstad’s paper on pharmacoeconomics in Tanzania is a great contribution.
In part, it addresses a generally held hypothesis that pharmacoeconomic studies are impossible in Tanzania and comparable countries because no data is available with which to conduct such analyses. Mori et al clearly demonstrate that researchers have overcome data barriers and successfully deploy pharmacoeconomic methods to guide resource allocation decisions. The lack of data is not entirely the rate limiter but rather the systematic collection and electronic recording of such data – a finding we shared with colleagues in our 2011 Health Policy paper.
Paper-based records are generally available at the level of health care purchasers and health facilities and when captured in an electronic database, various efficiency-related questions can be answered with pharmacoeconomic methods.
More resources are needed to facilitate this process.
Gender and treatment for HIV/AIDS, tuberculosis, and malaria in low and middle-income countries: A systematic review
João L. Carapinha, Dennis Ross-Degnan, Paul Ashigbie, Catherine Vialle-Valentin, Anita K. Wagner
PubMed Search Terms
#1 Medicines
((“drugs, generic” or “prescriptions, drug” or (pharmaceutical preparations) or drug utilization or pharmacoepidemiology or pharmacoeconomic* or prescribing[ti] or medicines[ti] or self-medication[ti] or self medication[ti] or “drug safety”[ti] or prescription fees or drugs, non-prescription or drug costs or drug information service[ti] or antibiotic or antiretroviral or ARV or antimicrobial or antimalarial or anti-malarial or “rational drug use” or (rational use[tw] and (medicine[tw] or medicines[tw] or drug[tw] or pharmaceutical[tw] or medication[tw]))) NOT (ah[sh] or ai[sh] or bi[sh] or bl[sh] or bs[sh] or cf[sh] or cs[sh] or ch[sh] or ci[sh] or cy[sh] or em[sh] or en[sh] or im[sh] or ir[sh] or ip[sh] or me[sh] or re[sh] or se[sh] or ul[sh] or ur[sh] or us[sh] or ve[sh]))
#2 Medicines Policies and Systems
(((Drug utilization and guideline adherence) or (pharmaceutical*[ti] and (advertising[ti] or promotion[ti] or marketing[ti])) or pharmaceutical care[ti] or dispensing[ti] or prescri*[ti] or formulary[ti] or formularies or “medication use”[ti] or (“drug use”[ti] not (narcotic or alcohol or illicit or drug abuse or substance-related disorders[mh]))) and (((policy[ti] or policies[ti]) not narcotic) or implement*[ti] or dissem*[ti] or improv*[ti] or chang*[ti] or interven*[ti] or optim*[ti] or influenc*[ti] or impact*[ti] or effect*[ti] or reduc*[ti] or increas*[ti] or modify*[ti] or adherence[ti] or nonadherence[ti] or “before and after”[ti])) or (attitude of health personnel and prescriptions, drug) or ((“persuasive communication” or “educational outreach”) and (“prescribing” or prescriber* or prescription* or pharmaci* or pharmac* or pharmaceutic*)) or (“academic detailing” or “drug detailing” or “counterdetailing” or “counter-detailing” or “detailers”) or (“educational outreach” and (prescribing or prescription*)) or (“drug donation” or “drug donations” or “pharmaceutical management”[tw] or “drug procurement” or “pharmaceutical procurement”) or (drug fund[tw] or ((drug[tw] or medicine[tw]) and revolving fund*) or (“bamako initiative”)) or ((“medicines policy”[ti] or “pharmaceutical policy”[ti] or “drug policy”[ti]) not (addict* or narcotic)) or (essential medicines[ti] or essential drugs[ti] or preferred drug[ti] or pharmaceutical benefits[ti] or pharmaceutical policy[ti]) or (“prescribing indicators”[ti]) or (rational drug use[ti] or “rational pharmacotherapy”[ti] or “medicine taking”[ti] or “dispensing errors”[ti] or “prescribing errors”[ti] or “generic substitution”[ti] or “pharmacy intervention”[ti] or “injection safety” or “injection use” or ((rational use[ti] or irrational use[ti] or appropriate use[ti] or inappropriate use[ti]) and (drugs [ti] or medicines[ti]))) or ((antibiotic use[ti] or antimicrobial use[ti] or antibiotic utilization[ti] or antimicrobial utilization[ti] or antibiotic utilisation[ti] or (malaria*[ti] and drug*[ti] and (use[ti] or utilization[ti] or utilization[ti]))) and ((reduc*[ti] or improv*[ti] or interven*[ti] or optimiz*[ti] or changing[ti] or changes[ti]) or intervention)) or ((antibiotic or antimicrobial or malaria or tuberculosis) and (intervention or controlled trial) and ((prescribing[ti] or reduc*[ti] or improv*[ti] or interven*[ti] or optimi*[ti] or chang*[ti] or guideline*[ti] or effectiveness[ti]) and (clinical guideline or prescribing or quality of care or drug utilization or compliance or adherence or professional competence) or education))
#1 OR #2 to create subset #3, i.e. all research related to medicines with an explicit inclusion of “antibiotic or antiretroviral or ARV or antimicrobial or antimalarial or anti-malarial” as a way to include medicines related to HIV/AIDS, TB, and malaria.
#4 Action Titles
((disseminat*[ti] or implement*[ti] or evaluat*[ti] or influenc*[ti] or adherence[ti] or nonadherence[ti] or compliance[ti]) and (guideline[ti] or guidelines[ti] or innova* [ti] or improv*[ti])) or ((efficac*[ti] or assess*[ti] or result[ti] or results[ti] or impact[ti] or impacts[ti] or impacting[ti] or effect*[ti] or evaluat*[ti] or measur*[ti] or fail*[ti]) and (intervention[ti] or interventions[ti] or policy[ti] or policies[ti] or program*[ti] or guideline[ti] or guidelines[ti] or experiment[ti] or experiments[ti] or experimental[ti] or practice*[ti])) or ((decrease[ti] or decreases[ti] or decreasing[ti] or reduce[ti] or reduc*[ti] or increase[ti] or increasing[ti] or controlling[ti] or facilitat*[ti] or shift[ti] or collaborat*[ti]) and (error[ti] or errors[ti] or irrational[ti] or inappropriate[ti])) or ((monitoring[ti] or auditing[ti] or “audit and feedback”[ti] or changing[ti] or chang*[ti] or improv*[ti] or increas*[ti] or optimi*[ti]) and (use[ti] or knowledge[ti] or practice[ti] or practices[ti] or behavior[ti] or behav*[ti] or compliance[ti] or comply[ti] or non compliance[ti] or adherence[ti] or nonadherence[ti] or management[ti] or treatment[ti] or safety[ti] or quality[ti] or implement*[ti])) or self-medication[ti] or health seeking[ti]
#3 AND #4 to create subset #5, i.e. all medicines research that point to interventions and thus empirical research (experimental and quasi-experimental (cohort studies, case-control studies, etc.)
#6 Specific Disease Areas – HIV/AIDS, TB, and malaria
(*malaria*[ti] or tuberculosis[ti] or TB[ti] or HIV[ti] or human immunodeficiency virus[ti] or *malaria* or tuberculosis or TB or HIV or human immunodeficiency virus)
#5 AND #6 to create subset #7, i.e. all medicines research that point to intervention research about HIV/AIDS, TB and malaria studies. This subset contains abstracts with and without gender explicitly mentioned in the abstract.
#8 Gender
(men[MeSH Terms] OR women[MeSH Terms]) OR gender OR sex[MeSH Terms] OR sex factors[MeSH Terms] OR sex characteristics[MeSH Terms] OR sex differences OR men OR man OR male OR women OR woman OR female OR sex OR sex factors OR sex characteristics
#5 AND #6 AND #7 to create subset #9, i.e. all medicines research that point to intervention research constrained to HIV/AIDS, TB and malaria studies that include a gender dimension.
#10 Exclusions
historical article[pt] or editorial[pt] or news[pt] or letter[pt] or comment[pt] or biography[pt] or festschrift[pt] or interview[pt] or letter[pt] or news[ti] or biography[ti] or newspaper article[pt] or opinion[ti] or in vitro or tolerability or outbreak or pathogenesis or etiology or aetiology or neutropenia or antineoplastic or single-blind or double-blind or drug evaluation or therapeutic equivalency or bioequivalence or synthesis or cell or plant or transplant or clone or immunology or microbiology or metabolism or pharmacokinetics or toxicity or biosynthesis or chemistry or pharmacognosy or biotechnology or cytology or embryology or genetics or bacteremia or neutropenia or vaccination or congenital or genetic or neutrophils or phagocytosis or susceptibility or drugs, Chinese or illicit or methadone or heroin or narcotic or “anatomy and histology”[sh] or “animals”[mh] or radio*[mh]
#9 NOT #10 to create subset #11, i.e. excluding material that relates to interventions not of interest such as clinical trials, animal and plant studies, and excluding material not considered empirical research such as newspapers, letter to the editor, editorial, etc. This is performed on search #7 that contains articles with and without gender explicitly mentioned in the abstract.
#12 Developing Countries
Afghanistan OR Albania OR Algeria OR Andorra OR Angola OR Antigua and Barbuda OR Argentina OR Armenia OR Aruba OR Azerbaijan OR Bahrain OR Bangladesh OR Barbados OR Belarus OR Belize OR Benin OR Bhutan OR Bolivia OR Bosnia and Herzegovina OR Botswana OR Brazil OR Bulgaria OR Burkina Faso OR Burundi OR Cambodia OR Cameroon OR Cape Verde OR Cayman Islands OR Central African Republic OR Chad OR Chile OR China OR Colombia OR Comoros OR Congo, Dem. Rep. OR Congo, Rep. OR Costa Rica OR Côte d’Ivoire OR Croatia OR Cuba OR Czech Republic OR Djibouti OR Dominica OR Dominican Republic OR Ecuador OR Egypt OR El Salvador OR Equatorial Guinea OR Eritrea OR Estonia OR Ethiopia OR Fiji OR Gabon OR Gambia OR Georgia OR Ghana OR Gibraltar OR Greece OR Grenada OR Guatemala OR Guinea OR Guinea-Bissau OR Guyana OR Haiti OR Honduras OR Hungary OR India OR Indonesia OR Iran OR Iraq OR Jamaica OR Jordan OR Kazakhstan OR Kenya OR Kiribati OR Korea OR Kosovo OR Kyrgyz Republic OR Lao PDR OR Latvia OR Lebanon OR Lesotho OR Liberia OR Libya OR Lithuania OR Macao OR Macedonia OR Madagascar OR Malawi OR Malaysia OR Maldives OR Mali OR Malta OR Marshall Islands OR Mauritania OR Mauritius OR Mayotte OR Mexico OR Micronesia OR Moldova OR Mongolia OR Montenegro OR Morocco OR Mozambique OR Myanmar OR Namibia OR Nepal OR Netherlands Antilles OR New Caledonia OR Nicaragua OR Niger OR Nigeria OR Northern Mariana Islands OR Oman OR Pakistan OR Palau OR Panama OR Papua New Guinea OR Paraguay OR Peru OR Philippines OR Poland OR Puerto Rico OR Romania OR Russia OR Rwanda OR Samoa OR San Marino OR São Tomé and Principe OR Saudi Arabia OR Senegal OR Serbia OR Seychelles OR Sierra Leone OR Slovak Republic OR Slovenia OR Solomon Islands OR Somalia OR South Africa OR Sri Lanka OR St. Kitts and Nevis OR St. Lucia OR St. Vincent and the Grenadines OR Sudan OR Suriname OR Swaziland OR Syrian Arab Republic OR Tajikistan OR Tanzania OR Thailand OR Timor-Leste OR Togo OR Tonga OR Trinidad and Tobago OR Tunisia OR Turkey OR Turkmenistan OR Tuvalu OR Uganda OR Ukraine OR Uruguay OR Uzbekistan OR Vanuatu OR Venezuela OR Vietnam OR West Bank and Gaza OR Yemen OR Zambia OR Zimbabwe
#11 AND #12 to create subset #13, i.e. all medicines research in low and middle-income countries that point to intervention research constrained to HIV/AIDS, TB and malaria studies including all gender specific articles.
Analogous search terms were used for JStor, ISI Web of Science, the International Network for the Rational Use of Drugs (INRUD) Bibliography, the disease-specific INRUD ART Adherence Bibliography, and the WHO Database on Medicines Use in Primary Care in Developing and Transitional Countries.
- Carapinha, J. (2000) Continuing Professional Development in Human Resource Management. Journal of Modern Pharmacy, 7 (10), 1-6.
- Carapinha, J. (2003) Rational Self-Medication within a South African Context. The Journal of Modern Pharmacy, February 2003.
- Carapinha, J. (2005) Ethical Decision Making in Managed Health Care. South African Pharmaceutical Journal, 72 (2).
- Carapinha, J. (2005) Evidence-Based Pharmacy Practice. South African Pharmaceutical Journal, 72 (4).
- Carapinha, J. (2006) The Value of Medicine in Improving the Quality of Care. Journal of South African Family Practice, 2006;48(10):6-10.
- Carapinha J. Producing Affordable Medicines in South Africa. In: Cohen JC, Illingworth P, Schuklenk U, editors. The Power of Pills. Maryland: Pluto Books; 2006. 251-259.
- Carapinha, J. (2008) Setting the Stage for Risk-Sharing Agreements: International Experiences and Outcomes-based Reimbursement. Journal of South African Family Practice, 2008;50(4):62-65.
- Carapinha, J. (2008) Policy Guidelines for Risk-sharing agreements in South Africa. Journal of South African Family Practice, 2008;50(5):43-46.
- Carapinha, J. (2008) Private pharmacies in an integrated approach to HIV/AIDS services. Journal of Social Aspects of HIV/AIDS, 2008 December; 5(4): 206-209.
- Carapinha, J. (2008) An Integrated Approach to HIV/AIDS Services in South Africa: Private Pharmacies and Policy Recommendations. Africa Policy Journal, Spring/Summer 2008 Edition. Volume 4. Harvard Kennedy School of Government.
- Carapinha, J. Ross-Degnan, D. Desta, AT. Wagner, A. (2011) Health insurance systems in five Sub-Saharan African countries: medicine benefits and data for decision making. Health Policy, 2011; 99(3): 193-202.
- Carapinha, J. Ross-Degnan, D. Vialle-Valentin, C. Wagner, A. (2012) Gender and treatment for HIV/AIDS, tuberculosis, and malaria in LMIC: A systematic review. (In Press)
The book ‘What You Should Know About Generic Medicine?’ is published to debunk the myth that generic drugs are of lower quality as compared to branded drugs. Programme Chairman for the USM’s Discipline of Social and Administrative Pharmacy and also editorial chairman, Associate Prof. Mohamed Azmi Ahmad Hassali said generic medicines should be safe and as efficacious as branded or innovator product. Director of USM Press, Profesor Dato’ Dr. Md. Salleh Yaapar who was also present at the ceremony said this book will help patients as well as heath practitioners to educate the public on the flawed perception of generic drugs. Dean School of Pharmaceutical Sciences (PPSF), Prof Madya Syed Azhar Syed Sulaiman said this book has a very significant role to educate the public on this issue. The book will be on sale at the USM co-operative bookshop and MPH Bookstores at RM 10 (USD 3.50) per copy. Order Form.
Victoria Hale, Medicines360′s CEO, believes the pharmaceutical business model is broken. Hale presented at the Unite for Sight conference in New Haven and informed delegates that pharma companies profit excessively from medicine sales and enourmous marketing budgets shadow R&D expenditure. Furthermore, she believes that society should purchase medicinal products from companies that benefit humanity.
Talking about business models, Hale presented how Medicines360 operates, but if you take a closer look, how radically different is her business model compared to those of many pharma firms? Medicines360 diversifies its income and is partly dependent on sales for its financial sustainability – ditto for other pharma firms. Her business focus is medicines for neglected conditions among people in developing countries. Traditional pharma firms have also made some significant strides in this direction through innovative prize funds.
So how different is Medicines360? Based on what was presented at the conference, not much. Is their model a radical departure from current models? Perhaps a comparison of their balance sheet with those of traditional pharma firms may help, but I suspect that very little would be different.
Be as it may, Medicines360 may be the first step in the direction of a conversation about business models that enable all patients when in need to access medicines.
Joao, from New Haven, CT
Multinational medicine producers are fighting government action in Turkey to reduce medicine prices. Government regulation will definitely impact the bottom line but in the bigger picture (and from a multinational perspective) how much of it is actually relevant? A loss in Turkey is subsidised by a gain in a different country and it may require a rebalancing of the tax reporting protocols for countries in which the company operates. Government regulation may also result in job losses but why do that when your competitors may find a profitable way of operating and may absorb that labour. All it does is reduce your ability to compete and increases your costs of hiring and retraining when periods of expansion roll around. Turkey’s medicine market is set to expand as are other emerging markets so all producers will benefit in the long run, so there’s no need to fight cheap medicines. Best regards, Joao
