Shaping markets to benefit global health - A 15-year history and lessons learned from the pentavalent vaccine market.

Market shaping for health products used in lower-income countries strives to benefit public health. As a funder of vaccines, Gavi, The Vaccine Alliance (Gavi) has goals for its market shaping efforts, achieved through a strategy developed and implemented by the Gavi Secretariat, UNICEF, the World Health Organization (WHO) and the Bill & Melinda Gates Foundation (BMGF). A case-study of Gavi's fifteen-year engagement with a vaccine against diphtheria, tetanus, pertussis, hepatitis B and haemophilus influenzae type b (pentavalent) provides evidence of the benefits and potential risks of trying to influence markets. During 2001-18, Gavi disbursed US$3.5 billion to support use of 50 million pentavalent doses annually before 2005, increasing to ∼300 million doses annually by 2016. During this time, eight manufacturers invested in vaccine development and manufacturing and the first two manufacturers have subsequently ceased production. Following its strategy, Gavi implemented coordinated market interventions including technical assistance to manufacturers, improving market information transparency, risk-sharing agreements and innovative procurement aiming to stimulate and capitalize on a competitive market. In 2018 supply allows ∼80 million children per year to be immunised, a sixteen-fold increase from 2005, with vaccine-related costs per child for donors and countries of one-quarter the 2005 level. Lessons learned include the importance of frameworks and strategies; the need to adjust interventions with changing conditions; the important role of manufacturers; and the potentially powerful effects of interconnected markets. This case study is limited by its focus on a single health product in a specific market, however the lessons can inform other market shaping efforts when taken in context. While countries and children have improved vaccine access, risks of financial sustainability and continued manufacturer investment in Gavi vaccine markets are being monitored. Gavi should continue implementing a market shaping strategy, adjust with market conditions and expect and measure unintended consequences.

Tendencias del consumo y precio promedio ponderado sobre los costos de los medicamentos anti-infecciosos en un hospital pediátrico / Tendency of the consumption and weighted average price over the cost of anti-infective drugs in a pediatric hospital

Introducción. Se evalúa la tendencia de consumo, precio promedio ponderado (PPP) y costo total, así como la influencia del consumo y PPP sobre los costos totales, en los subgrupos de medicamentos (dosis diaria definida/100 días-cama) antibacterianos, antimicóticos, antimicobacterianos y antivirales de 2005 a 2007. Métodos. De la base de datos de la farmacia del hospital, se calcularon, para cada medicamento, su consumo, PPP y costo total de los cuatro subgrupos terapéuticos. El análisis estadístico fue regresión lineal múltiple y coeficiente de correlación de Spearman. Resultados. El subgrupo con mayor consumo y costo fue el de antibacterianos, y el de mayor precio ponderado el de los antivirales. Se identificó que el consumo y los precios ponderados influyeron significativamente en los costos totales. El cambio por cada unidad de consumo y de precio ponderado produjo un incremento de $190,893.8 USD (IC95% 118,196.1-263,591.6) y de $3,050.4 USD (IC95% 1,912.5-4,188.3), respectivamente. Conclusiones. El aumento porcentual progresivo del costo de los antiinfecciosos en comparación con el total de grupos terapéuticos del hospital fue consecuencia del consumo y de los PPP. El análisis estadístico empleado y el uso de las variaciones porcentuales permitieron identificar, por subgrupos terapéuticos, el efecto que los consumos y los PPP tienen sobre los costos totales. El análisis individual de los medicamentos de alto costo también permitió interpretar algunos comportamientos; por lo que se recomienda efectuar este tipo de evaluaciones para identificar las diversas variables que influyen en los costos.

Background. We undertook this study to evaluate the tendency of the consumption (defined as daily doses/100 bed-days), the weighted average price (WAP) and the total cost of antibacterials, antimycotics, antimycobacterials and antiviral subgroups from 2005 to 2007, as well as the influence of the consumption and the WAP on the total costs. Methods. We used the database of the hospital pharmacy in order to calculate consumption, WAP and total cost of each drug for therapeutic subgroups. Multiple linear regression and Spearman correlation coefficient were used for statistical analyses. Results. The antibacterial subgroup showed the highest consumption and the total cost. The antiviral subgroup showed the highest WAP. Consumption and WAP had a significant influence on the total costs. The change by each unit of consumption and WAP produced an increase of 190,893.8 USD (95% CI 118,196.1-263,591.6) and 3,050.4 USD (95% CI 1,912.5-4,188.3), respectively. Conclusion. The progressive percentage increase of the total cost of anti-infective drugs in comparison with the total cost of hospital's therapeutic subgroups was due to the consumption and WAP. Statistical analysis and percentage of variations can identify the effect of consumption and WAP on total costs according to therapeutic subgroups. The analysis of high-cost drugs allows interpretation of some behaviors. Therefore, it is recommended to carry out these types of evaluations so as to identify the different variables that can influence costs.