E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue
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Dear e-druggers,
It is already some years ago that I laid my eyes for the first time on artemether/lumenfantrine 20/120mg tablets presented in four different package forms with the brand name Coartem in relatively big letters on each package form. It was presented as, if I am not mistaken, product(s) especially developed for the public health sector by Novartis following an agreement with WHO. Please correct me if I am wrong. At the time, my first reaction was that there was something wrong with Coartem, but did not give it much further thought. However, recently I was requested to look into the procurement and management supply aspects of the introduction of artemether/lumenfantrine 20/120mg tablets in Uganda and this time I did study the issue more closely. I like to share with you the following questions that came up:
1. Is it not so, that with Coartem being marketed in four different products (package forms, colours and users instructions) that, in fact, one and the same tablet is being marketed as four different products? And that this way quantification, procurement, logistics and dispensing are being made more complicated than if it was packed as one product? And with extra costs for the packaging, storage space and transport?
2. Are we not suppposed to "talk generic" and avoid the use of brand names?
When I discussed these issues with some colleagues, their first reaction was that the different package forms may increase patient compliance. I searched the web , but could not find any studies to confirm this. On the contrary, in anecdotal cases health workers in the field denied such an effect. And with one or more of the four different package forms out-of-stock (which was the case most of the time in Uganda) the available ones are being divided in order to service all patients and this practice defeats any intention for possible better patient compliance anyway (in this case some patients have to be told to ignore the pre-printed instructions). Is there any e-drugger that knows about serious studies that proof better patient compliance due to Coartem?
I would plead for the introduction of the generic artemether/lumenfantrine 20/120mg tablets to be packed in blisters with 6 tablets each in cartons with 100 or more blisters. This way having one product that can be used for all four different age classes.
What are the experiences of the other e-druggers? Are the issues mentioned above serious enough to take some form of action?
Best regards,
Rob Verhage
Pharmacist
HERA Consultant
PO Box 4002
Paramaribo
Suriname
597 8561109
verhager@cq-link.sr
E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue (3)
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I suppose that the 4 different packages do have a different composition?
You're only mentioning the 20/120mg combination, I assume that the other
packs are meant for children with different dosage of drug substance
(active ingredient). Indeed difficult to understand that 4 combinations are
needed! and yes INN (International Non-proprietary Name) names should be
used to avoid confusions. Lets not forget that generic names are equally
confusing than brand names as generic companies do use similar techniques
as originator companies. They register their products under a brand name
and promote them as agressively. eg Triomune: is a generic product but has
a brand name.
* HIV exists, be aware and talk about it as silence kills *
[The moderator got the impression that there were actually 4 pack sizes of the same strength]
Jens Van Roey, MD
MSF Geneva
Jens.VANROEY@geneva.msf.org
E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue (2)
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Dear Rob,
Just to agree with your observations. Malawi is in the process of
changing to Coartem. The first consignment will be "smart" pushed to the
facilities and deciding how much of the four different packages to send
to the 600+ facilities (both govt. and CHAM) has been a challenge. If it
was one tin of 1000 I am sure it would have been much much easier. We
are yet to see how the distribution will go. CMS will distribute to all
the facilities.
Regards,
Cynthia
Cynthia Kamtengeni
MSH Malawi
ckamtengeni@mw.msh.org
E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue (4)
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Dear colleagues,
The subject presented by Rob has been broached here in Zambia in
recent months. We can testify to the fact that the management of
malaria treatment has been complicated by this presentation of this
brand of ACTs. Programming malaria treatment is understood in many
countries to be limited to the pack size of the ACTs. As in Malawi,
we're now more or less agreed that a pack of say 1000 x 6 tablet
strips would make a lot of sense, allowing programme staff to manage
treatment across the population.
However, programmes such as Malaria also have an obligation to
determine what pack size they need to have on their programmes.
Therefore, the question to ask is have governments discussed their
needs with manufacturers and donors to state their requirements? The
innovation brought about through the Coartem products clearly was not
set in stone, and thus governments could have reached different
arrangements for pack- sizes for their programmes. I am sure companies
such as Norvatis can accomodate such requests. This has been done for
other programmes, such as HIV/AIDS treatment by at least one country
that I know of, with moderate success in financing, management and
treatment.
Regards,
Dr. Bonface Fundafunda
Drug Supply Budget Line,
Ministry of Health,
Lusaka,
Zambia
bcfunda@hotmail.com
E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue (5)
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Dear Rob,
You have raised some very valid concerns, Rob.
The different packages of the same product actually adds more confusion to the medical staff and patients alike; not to mention the unnecessary added costs of packaging and distribution. These costs only make the product more costly for the final consumer. I believe that keeping it simply in one package form will save the staff and patients from all of these.
The above opinion is born out of our practical experience in a mission hospital setting in Jos, Nigeria. However, a proper study of this problem may clarify these issues, particularly with large scale distribution.
Best Regards,
Bulus T. Yayok
Chief Pharmacist
ECWA Evangel Hospital,
PMB 2238, Jos,
Plateau State - Nigeria.
phyayokbt@yahoo.com