Table 1.
Full list of references with cost implications from programmes
| Author and year | Level | Country/region | Intervention | Outcome measure | Results |
|---|---|---|---|---|---|
| Comprehensive drug system policy | |||||
| Chaudhury et al15 (2005) | Subnational | India | Evaluation of a comprehensive drug policy in Delhi which included development of an Essential Drugs List, a centralised pooled procurement system, and activities to promote rational drug use | Total savings to the Government of Delhi from drug purchases | Approximately 30% cost savings |
| Homedes, and Ugalde13 (2006) | National | Brazil | Multiple interventions by the Ministry of Health, including promotion of multisource drugs, the development of the Brazilian pharmaceutical industry and the use of provisions of the TRIPS agreements to engage in aggressive price bargaining with multinational pharmaceutical manufacturers | Annual cost per person of ARV treatment | Costs reduced from US$4860 in 1997 to US$2530 in 2001 (48% reduction) and to about US$1000 in 2003 (60% reduction, for a total reduction of 79% in 6 years) |
| Li et al14 (2013) | National | China | Evaluation of the National Essential Medicines Scheme, which included a National Essential Drugs List, a grassroots zero-mark-up policy, reimbursements for drugs on the list and public procurement of drugs | Total cost of drugs in select districts for treating (1) pneumonia or bronchitis, and (2) gastroenteritis | Costs decreased by 17.5% for patients with pneumonia (p<0.05) and 48.4% for patients with gastroenteritis (no significance figure reported) |
| Centralised procurement/tender | |||||
| Adesina et al21 (2013) | National | Mexico | Evaluation of the Mexican Commission for Price Negotiation on the price of ARV drugs | Cost savings from negotiation process for 12 ARV drugs | 38% reduction in total spend on ARV drugs (but prices still above those in other upper-middle-income countries) |
| Alabbadi19 (2011) | National | Jordan | JPD of Jordan bids for four government agencies and aims to unify purchases of drugs and medical supplies to reduce the cost of purchased drugs | Savings from joint purchasing for all drugs in first year of JPD | 5.2% savings achieved; 17% savings reported when one drug (cephalexin), whose raw material prices doubled that year, excluded from analysis |
| Al-Abbadi et al20 (2009) | National | Jordan | Establishment of a joint procurement system across four different government agencies | Total savings to the four agencies | 8.9% reduction in spend on drugs using joint procurement system |
| Amaral and Blatt24 (2011) | Subnational | Brazil | Intermunicipal Health Consortium used to procure drugs for multiple municipalities after a government policy decentralising procurement to the municipality level | Number of drugs with reduced unit prices | 76% of drugs had a reduction in unit price within 2 years of programme implementation |
| Chaumont et al22 (2015) | National | Mexico | Creation of the Coordinating Commission for Negotiating the Price of Medicines (CCNPM) to negotiate prices for drugs, especially ARVs | Annual treatment cost for various ARVs in Mexico compared to HICs, UMICs, and LMICs | ARV prices were ‘higher than those paid by similar upper-middle income countries’ and were higher than prices in HICs in some cases |
| Danzon et al49 (2015) | International | Brazil, China, Algeria, Egypt, India, Indonesia, Philippines, Thailand, South Africa, and French West Africa | Tendered procurement by NGOs for cardiovascular and anti-infective drugs (including HIV and TB drugs) in LMICs | Comparison of retail originator drug prices to tendered originators and tendered generic drugs | Price for tendered originators was 42.4% less than the price for retail originators; price for tendered generics was 66.8% less than the price for retail originators |
| DeRoeck et al16 (2006)* | International | Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates | GCC group purchasing programme which centralised tender and two times a day processes | Savings on price for vaccines procured through the group purchasing programme | 4–46% price reduction on six vaccines |
| DeRoeck et al16 (2006)* | International | Latin America | PAHO EPI Revolving Fund, which purchases vaccines and immunizations on behalf of countries in Latin America and the Caribbean | Savings on price for vaccines procured through Revolving Fund vs those supplied directly to countries before creation of the fund | 70–82% price savings on vaccines and immunisations |
| Ewen et al9 (2014) | International | Palestine (Gaza/The West Bank), Jordan, Lebanon, Syria | Comparison of different procurement mechanisms for drugs by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA); analysis of price differences when drugs procured using central tender vs locally by each field site | Prices of medicines including antidiabetic medicines, antimicrobials, antihypertensives and antipyretics | Syria paid 20% less for drugs procured locally; Lebanon paid 83% more for drugs procured locally and West Bank paying 128% more for drugs procured locally |
| Gomez-Dantes et al23 (2012) | National | Mexico | Introduction of the Coordinating Commission for Negotiating the Price of Medicines and other health inputs (CCPNM) in 2008 | Annual direct savings on public expenditure for public medicines since introduction of CCPNM | Annual savings from US$52.1 million—US$121.8 million in the first four years of CCPNM |
| Huff-Rousselle and Burnett18 (1996) | International | Caribbean | ECDS, which provides pooled procurement services to nine small island nations | Average savings on drugs procured through ECDS after first tender cycle | 16.1–66.1% savings across different countries |
| Khoja and Bawazir17 (2005) | International | Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates | Group purchasing agreement among six countries via the GCC | Total cost savings to member countries | ‘According to a study performed by GCC Executive Offices in 1992, total of US$33 million was saved by the five GCC states. Furthermore, more than US$11 million was saved by 3 GCC states in 2001.’ |
| Milovanovic et al25 (2004) | Subnational | Serbia | Evaluation of a drug tender process of 479 drug formulations by a university hospital | Cost savings compared to free market price | 17.2% cost savings from drug tender compared to free market price for basket of drugs purchased |
| Sigulem and Zucchi26 (2009) | Subnational | Brazil | E-procurement tool used to facilitate joint purchasing of medications by multiple hospitals within a network | Change in unit price of drugs from (1) before joint purchasing to beginning of joint purchasing, and (2) from beginning of joint purchasing to last joint purchase over 2-year period | Of 37 drugs included, 34 showed price reductions after implementation of e-procurement system, and 27 showed further decreases in price over the following 2 years |
| Supply chain management | |||||
| Hamel et al50 (2015) | Subnational | Nigeria | Programme to strengthen laboratory services in hospitals and clinics, with procurement of more efficient equipment, laboratory modifications, supply chain management and trainings; programme involved securing reduced reagent costs due to high volume of regular laboratory tests | Reduction in cost/test for specific tests | CD4+ cell count test reduced from US$22/test to US$2/test; routine chemistry tests (such as alanine aminotransferase) reduced from >US$1/test to US$0.29/test; viral load tests reduced from US$33/test to US$14/test |
| Lloyd et al (2015)51 | Subnational | Tunisia | Modification of methods to store and transport vaccines, including the use of electric utility vehicles for regular deliveries | Energy costs for storage and distribution of vaccines | 20.16% reduction in costs after implementation of supply chain improvements |
| Riewpaiboon et al27 (2015) | National | Thailand | Transition to VMI system to manage vaccine supply chain | Total cost per dose of vaccine procured | Costs increased from US$1.35 (conventional system) to US$1.43 (VMI) |
| Other | |||||
| Bevilacqua et al10 (2011) | Subnational | Brazil | Study of the impact of requiring bioequivalence and/or bioavailability studies as part of the procurement of generic medicines | Change in total procurement cost of the same quantity of 150 medicines before and after the policy | Total costs increased by 87% after implementation of the policy because test failure rates increased from 2.6% before the policy to 56.9% after the policy |
| Maiga et al38 (2003) | Subnational | Mali | Comparison of city (Niono) where public health system regularly supplies drugs with another city (Koutiala) where public health system does not supply drugs, limiting supply to availability in private sector | Cost of drugs to consumers after accounting for the content of transactions (ie, type and quantity of drugs) | Drugs cost 32% less in city where public health system supplied drugs |
| Ramani39 (2006) | Subnational | India | Implementation of a reengineered, IT-enabled system to purchase hospital supplies | Cost to purchase common items | 7.7% reduction in cost of purchase for common items after implementation of system |
| Thuray et al40 (1997) | National | Sierra Leone | Procurement of drugs and supplies directly from commercial supplier, rather than through standard governmental channels, by a PMM team under the Ministry of Health and with external partner support | Reduction in total costs for drugs and supplies associated with select obstetric procedures in conditions (comparison between PMM costs vs hospital pharmacy costs) | 28% price reduction for treating sepsis/induced abortion (non-surgical); 30% price reduction for treating eclampsia; 49% price reduction for obstetric surgery; 54% price reduction for treating postpartum haemorrhage |
| Tougher et al36 (2012) | International | Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania | Evaluation of the AMFm, which included price reductions through negotiations with manufacturers of QAACTs; a buyer subsidy, via a copayment by the Global Fund to participating manufacturers, for purchases made by eligible public, private and non-governmental organisation importers; and interventions to support AMFm implementation and promote appropriate antimalarial use | Manufacturer price of QAACTs sold to private, for-profit buyers; median price of QAACTs sold in the private, for-profit sector | Manufacturer price reduced 29–78% depending on package size; Median price to consumers dropped in all seven pilot countries, with a statistically significant drop (p<0.0001) for five of seven countries |
| Witter (2007)52 | Subnational | Sudan | RDF which oversees procurement, distribution and sale of drugs | Prices of drugs for its list of essential drugs | Drugs 40% cheaper than CMSPO and 100% cheaper than private sector outlets |
*Note that these entries refer to the same citation, which reports results from two different programmes.
AMFm, Affordable Medicines Facility-malaria; ARV, antiretroviral treatments; CCNPM, Coordinating Commission for Negotiating the Price of Medicines; CMSPO, Central Medical Supplies Public Organisation; ECDS, Eastern Caribbean Drug Service; EPI, Expanded Programme on Immunisation; GCC, Gulf Cooperation Council; HICs, high-income countries; JPD, Joint Procurement Directorate; LMICs, low-income and middle-income countries; PAHO, Pan-American Health Organization; PMM, preventing maternal mortality; QAACTs, quality-assured ACTs; RDF, revolving drug fund; UMICs, upper-middle income countries; VMI, vendor managed inventory.