title: Predicting Global Fund grant disbursements for procurement of artemisinin-based combination therapies.
abstract: BACKGROUND
  An accurate forecast of global demand is essential to stabilize the market for artemisinin-based combination therapy (ACT) and to ensure access to high-quality, life-saving medications at the lowest sustainable prices by avoiding underproduction and excessive overproduction, each of which can have negative consequences for the availability of affordable drugs. A robust forecast requires an understanding of the resources available to support procurement of these relatively expensive antimalarials, in particular from the Global Fund, at present the single largest source of ACT funding.
  
  
  METHODS
  Predictive regression models estimating the timing and rate of disbursements from the Global Fund to recipient countries for each malaria grant were derived using a repeated split-sample procedure intended to avoid over-fitting. Predictions were compared against actual disbursements in a group of validation grants, and forecasts of ACT procurement extrapolated from disbursement predictions were evaluated against actual procurement in two sub-Saharan countries.
  
  
  RESULTS
  Quarterly forecasts were correlated highly with actual smoothed disbursement rates (r = 0.987, p < 0.0001). Additionally, predicted ACT procurement, extrapolated from forecasted disbursements, was correlated strongly with actual ACT procurement supported by two grants from the Global Fund's first (r = 0.945, p < 0.0001) and fourth (r = 0.938, p < 0.0001) funding rounds.
  
  
  CONCLUSIONS
  This analysis derived predictive regression models that successfully forecasted disbursement patterning for individual Global Fund malaria grants. These results indicate the utility of this approach for demand forecasting of ACT and, potentially, for other commodities procured using funding from the Global Fund. Further validation using data from other countries in different regions and environments will be necessary to confirm its generalizability.
authors.affiliation: Clinton Foundation HIV/AIDS Initiative, Center for Strategic HIV Operations Research, 383 Dorchester Avenue, Suite 400, Boston, MA 02127, USA. jcohen@clintonfoundation.org
authors.forename: Justin M
authors.initials: JM
authors.lastname: Cohen
authors.forename: Inder
authors.initials: I
authors.lastname: Singh
authors.forename: Megan E
authors.initials: ME
authors.lastname: O'Brien
mesh_terms: D037621:Artemisinins / Q000191:economics* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005544:Forecasting; D005102:Health Expenditures / Q000639:trends*; D007783:Lactones / Q000191:economics* / Q000627:therapeutic use*; D008288:Malaria / Q000188:drug therapy*; D012044:Regression Analysis; D013223:Statistics as Topic
chemical_list: D037621:Artemisinins; D007783:Lactones; C075875:artemisin