Asthma situation and the

“Asthma Drug Facility” response

Providing access to affordable quality assured essential asthma medicines

Global Burden of Asthma

• 300 million cases worldwide, still increasing• Common chronic disease among children• Majority in low- and lower-middle income countries• Prevalence higher in urban areas• Asthma accounts for about 1 death in every 250 deaths

worldwide• Health cost of asthma increases with ineffective

management

Masoli M et al.

Burden of asthma. http://www.ginasthma.com

Challenges for management of asthma in poor countries

• Major cause of unplanned visits to health facilities in urban centres

• Low income and low health expenditure per capita• Priority is given to communicable diseases• Poor access to health services, particularly for the

long-term management needed for asthma• Lack of trained health personnel • Low or non-affordability of asthma medicines for

patients

1. Improve affordability of essential asthma medicines in developing countries

2. Improve skills of health personnel by the development of a training package

3.Assess quality of care by regular monitoring and evaluation

The Union’s response

Ait-Khaled N et al. Allergy 2007;62:230-36.

Why create the Asthma Drug Facility?Low affordability of drugs in many countries

High cost (=low affordability for patients) of essential asthma drugs, particularly inhaled corticosteroids, has been demonstrated since 1998 in The Union studies:– Majority of patients cannot afford the

essential medicines.– Minority of rich patients are purchasing

very costly unnecessary medicines.

Why create an ADF?Low affordability

Cost for the patient of 1 inhaler in US$

% of countries

< $5 15

$5-9 11

$10-29 48

$30-55

Do not know

4

22

Survey (46 countries), The Union and ADF, 2005

e.g. Inhaled beclometasone 250µg

Why create an ADF?The health costs arguments

Low and middle-income countries cannot afford to not treat asthma

Costs increase when asthma not treated or incorrectly treated. We need to:

Reduce unnecessary expense of emergency visits, hospitalisation, and ineffective and inappropriate medicinesReduce indirect costs on

patients, families, governments

How does the ADF work?

• ADF organises qualification of manufacturers and products (as part of its Quality Assurance system), since asthma inhalers are not part of the WHO Prequalification Programme

• ADF establishes contracts with selected manufacturers for qualified products and proposes these products to countries, organisations, programmes

• Countries purchase generics at affordable prices

• ADF provides training materials and EpiData information system

Additional services in collaboration with The Union:

• Training courses and technical assistance

What do ADF clients need to do?

Clients must agree to:

• Use the products supplied according to the 4 step approach for treatment and diagnosis proposed in The Union Asthma guide

• A minimum order of 5000 corticosteroid inhalers• Take the responsibility for the importation of medicines into the

recipient country• Sell the medicines with a minimal mark-up or to provide them

free of charge to patients• Not re-export or resell these medicines• Make a full payment in advance to ADF• Submit quarterly monitoring reports to ADF

ADF Products*Recommended in WHO Essential Medicines List 2009

**Add to this: the costs of transport and insurance, preshipment inspection and 10% fees for ADF services (including quality control)

Product Primary Supplier(Country)

Price per unit FCA** (Euro)

Beclometasone 100µg/puff, 200 doses, HFA inhaler*

Beximco(Bangladesh)

1.07

Salbutamol 100 µg/dose, 200doses, HFA inhaler*

Beximco(Bangladesh)

0.83

Budesonide 200µg/puff, 200 doses, HFA inhaler*

Cipla/Medispray(India)

2.69

Fluticasone 125µg/puff, 120 doses, HFA inhaler

Cipla/Goa (India)

3.23

What else needs to happen for improvedaccess to quality asthma care?

• Commitment from respiratory specialists, public health specialists, health workers, communities

• Convince governments tobuy essential medicines for the majority of patients

• Country adoption / adaptation of international asthma guidelines

Contact

Asthma Drug Facility

International Union Against Tuberculosis and Lung Disease (The Union)

68, Boulevard Saint-Michel

75006 Paris, France

Tel: (+33) 1 44 32 03 75

Fax: (+33) 1 43 29 90 87

ADF@theunion.org

Website: www.GlobalADF.org (in English, French and Spanish)