Estimating antimalarial drugs consumption in Africa before the switch to artemisinin-based combination therapies (ACTs).
BACKGROUND
Having reliable forecasts is critical now for producers, malaria-endemic countries and agencies in order to adapt production and procurement of the artemisinin-based combination treatments (ACTs), the new first-line treatments of malaria. There is no ideal method to quantify drug requirements for malaria. Morbidity data give uncertain estimations. This study uses drug consumption to provide elements to help estimate quantities and financial requirements of ACTs.


METHODS
The consumption of chloroquine, sulphadoxine/pyrimethamine and quinine both through the private and public sector was assessed in five sub-Saharan Africa countries with different epidemiological patterns (Senegal, Rwanda, Tanzania, Malawi, Zimbabwe). From these data the number of adult treatments per capita was calculated and the volumes and financial implications derived for the whole of Africa.


RESULTS
Identifying and obtaining data from the private sector was difficult. The quality of information on drug supply and distribution in countries must be improved. The number of adult treatments per capita and per year in the five countries ranged from 0.18 to 0.50. Current adult treatment prices for ACTs range US$ 1-1.8. Taking the upper range for both volumes and costs, the highest number of adult treatments consumed for Africa was estimated at 314.5 million, corresponding to an overall maximum annual need for financing ACT procurement of US$ 566.1 million. In reality, both the number of cases treated and the cost of treatment are likely to be lower (projections for the lowest consumption estimate with the least expensive ACT would require US $ 113 million per annum). There were substantial variations in the market share between public and private sources among these countries (the public sector share ranging from 98% in Rwanda to 33% in Tanzania).


CONCLUSIONS
Additional studies are required to build a more robust methodology, and to assess current consumptions more accurately in order to better quantify volumes and finances for production and procurement of ACTs.
Kindermans
Jean-Marie
JM
AEDES Foundation, Brussels, Belgium. jmkindermans@aedes.be
Vandenbergh
Daniel
D
Vreeke
Ed
E
Olliaro
Piero
P
D'Altilia
Jean-Pierre
JP
D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use; D004358:Drug Therapy / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D011739:Pyrimethamine / Q000627:therapeutic use; D012432:Rwanda / Q000453:epidemiology; D012675:Senegal / Q000453:epidemiology; D013413:Sulfadoxine / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology
D000962:Antimalarials; D037621:Artemisinins; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D011739:Pyrimethamine