Palafox Benjamin, Patouillard Edith, Tougher Sarah, Goodman Catherine, Hanson Kara, Kleinschmidt Immo, Torres Rueda Sergio, Kiefer Sabine, O'Connell Kate, Zinsou Cyprien, Phok Sochea, Akulayi Louis, Arogundade Ekundayo, Buyungo Peter, Mpasela Felton, Poyer Stephen, Chavasse Desmond
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK,
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Health Policy Plan. 2016 Mar;31(2):148-60. doi: 10.1093/heapol/czv031. Epub 2015 May 5.
The private for-profit sector is an important source of treatment for malaria. However, private patients face high prices for the recommended treatment for uncomplicated malaria, artemisinin combination therapies (ACTs), which makes them more likely to receive cheaper, less effective non-artemisinin therapies (nATs). This study seeks to better understand consumer antimalarial prices by documenting and exploring the pricing behaviour of retailers and wholesalers. Using data collected in 2009-10, we present survey estimates of antimalarial retail prices, and wholesale- and retail-level price mark-ups from six countries (Benin, Cambodia, the Democratic Republic of Congo, Nigeria, Uganda and Zambia), along with qualitative findings on factors affecting pricing decisions. Retail prices were lowest for nATs, followed by ACTs and artemisinin monotherapies (AMTs). Retailers applied the highest percentage mark-ups on nATs (range: 40% in Nigeria to 100% in Cambodia and Zambia), whereas mark-ups on ACTs (range: 22% in Nigeria to 71% in Zambia) and AMTs (range: 22% in Nigeria to 50% in Uganda) were similar in magnitude, but lower than those applied to nATs. Wholesale mark-ups were generally lower than those at retail level, and were similar across antimalarial categories in most countries. When setting prices wholesalers and retailers commonly considered supplier prices, prevailing market prices, product availability, product characteristics and the costs related to transporting goods, staff salaries and maintaining a property. Price discounts were regularly used to encourage sales and were sometimes used by wholesalers to reward long-term customers. Pricing constraints existed only in Benin where wholesaler and retailer mark-ups are regulated; however, unlicensed drug vendors based in open-air markets did not adhere to the pricing regime. These findings indicate that mark-ups on antimalarials are reasonable. Therefore, improving ACT affordability would be most readily achieved by interventions that reduce commodity prices for retailers, such as ACT subsidies, pooled purchasing mechanisms and cost-effective strategies to increase the distribution coverage area of wholesalers.
私营营利性部门是疟疾治疗的重要来源。然而，私人患者面临着单纯性疟疾推荐治疗药物青蒿素联合疗法（ACTs）的高昂价格，这使得他们更有可能接受更便宜、效果更差的非青蒿素疗法（nATs）。本研究旨在通过记录和探究零售商及批发商的定价行为，更好地了解消费者购买抗疟药物的价格情况。利用2009 - 2010年收集的数据，我们给出了六个国家（贝宁、柬埔寨、刚果民主共和国、尼日利亚、乌干达和赞比亚）抗疟药物零售价格以及批发和零售层面价格加成的调查估计值，同时还给出了关于影响定价决策因素的定性研究结果。nATs的零售价格最低，其次是ACTs和青蒿素单一疗法（AMTs）。零售商对nATs的加价百分比最高（范围：尼日利亚为40%，柬埔寨和赞比亚为100%），而ACTs（范围：尼日利亚为22%，赞比亚为71%）和AMTs（范围：尼日利亚为22%，乌干达为50%）的加价幅度在数值上相似，但低于nATs。批发加价通常低于零售层面，且在大多数国家，不同抗疟药物类别的批发加价相似。在定价时，批发商和零售商通常会考虑供应商价格、现行市场价格、产品可得性、产品特性以及与运输货物、员工工资和维护房产相关的成本。经常会使用价格折扣来促进销售，批发商有时也会用其奖励长期客户。只有在贝宁存在定价限制，该国批发商和零售商的加价受到监管；然而，露天市场上的无证药品供应商并不遵守定价制度。这些研究结果表明，抗疟药物的加价是合理的。因此，通过降低零售商商品价格的干预措施，如ACT补贴、联合采购机制以及提高批发商分销覆盖区域的成本效益策略，最容易实现提高ACT可承受性的目标。
