Table 3.

Definitions of secondary outcomes

Term	Operational definition	Measurement unit
Transparency	See price transparency in Table 1.	Qualitative description, as presented in literature
Efficiency	AHRQ’s definition: Avoiding waste, including waste of equipment, supplies, ideas, and energy. Allocative efficiency: Allocating resources in such a way as to provide the optimal mix of goods and services to maximise the benefits to society Technical efficiency: Using the least amount of resources or the right combination of inputs to produce a given mix of goods and services	As measured and presented in literature or qualitative description, as presented in literature Qualitative measures of process efficiency, e.g. timeliness, resource-intensiveness
Shortage	EMA’s definition: a shortage of a medicinal product occurs when there are changes to either demand or supply of the medicine, so that clinical need can no longer be met. A medicine shortage causes temporary unavailability. The total stock across all levels of the national supply chain, across all geographical regions, cannot meet demand during a medicine shortage	As measured and presented in literature or qualitative description, as presented in literature
Quality of pharmaceutical products	Whether products are substandard or falsified (SF) WHO’s definitions: Substandard: Also called “out of specification”, these are authorized medical products that fail to meet either internationally accepted quality standards or specifications, or both. Falsified: Medical products that deliberately/fraudulently misrepresent their identity, composition or source.	Occurrence of SF products
Safety	IOM’s definition: the prevention of harm to patients	As measured and presented in literature
Unethical conduct	Business or professional conduct that contravenes social norms or social responsibilities	Qualitative description, as presented in literature
Illegal conduct	Business or professional conduct that contravenes the law	Qualitative description, as presented in literature
Equity	Differences in [access or] health that are avoidable and also considered unfair or unjust	Qualitative assessment, including assessing differences in the relative effect size of the intervention; assessing indirectness of evidence to disadvantaged populations and/or settings.

AHRQ: Agency for Healthcare Research and Quality, EMA: European Medicines Agency, IOM: Institute of Medicine, WHO: World Health Organization