Raffaella’s Literature Update

The following message is courtesy of Dr Raffaella Ravinetto, Public Health Department, Institute of Tropical Medicine Antwerp, Belgium.

Ref:  Gabel J; Difäm-EPN Minilab Network; Martus P, Heide L. Relationship between Prices and Quality of Essential Medicines from Different Manufacturers Collected in Cameroon, the Democratic Republic of the Congo, and Nigeria. Am J Trop Med Hyg. 2024 Oct 8:tpmd240309. 

Dear Friends, 

I am happy to share a new paper coming from the rich collaboration between the Ecumenical Pharmaceutical Network and the group of Lutz Heide in Tuebingen. If you have time, please read the full manuscript. Otherwise, I recommend reading at least this summary: these findings challenge the common assumption that adequate quality assurance would invariably cause an increase in medicine prices.

Best, 

Raffaella

Achieving universal access to affordable medicines, and at the same time assuring the quality of medicines, may present a challenge especially in low- and middle-income countries. In a recent study by researchers from the University of Tuebingen and from members of the Ecumenical Pharmaceutical Network, the relationship between medicine prices and medicine quality was investigated in Cameroon, the Democratic Republic of the Congo, and Nigeria. From different types of health facilities and medicine vendors, 711 samples of essential medicines were purchased and analyzed for their quality (= content and dissolution of the active pharmaceutical ingredients). All originator brand medicines, as well as all generic medicines manufactured in countries with stringent regulatory authorities (hereafter called “SRA generics”; manufactured in the Global North) complied with pharmacopeial specifications. In contrast, of the generic medicines manufactured in countries without stringent regulatory authorities (“non-SRA generics”; manufactured in the Global South), 21.1% were substandard. Unsurprisingly, however, the originator brands and SRA generics were markedly more expensive than non-SRA generics. The non-SRA generics comprised branded and non-branded generics; both were found to have similar prices and similar quality. Falsified medicines were found among all categories of medicines; their prices were similar to those of the non-SRA generics. Even within the non-SRA generics, medicine prices varied widely; however, higher prices did not (!) correlate with higher qualityOn the contrary, medicines produced by manufacturers for which WHO had published Public Inspection Reports (WHOPIRs) showed significantly lower prices (by 33%!) than other non-SRA generics, but at the same time comprised significantly fewer substandard medicines. 

These findings challenge the assumption that adequate quality assurance would invariably cause an increase in medicine prices.

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