Modeling)Future) AMFm)Scenarios)
AMFm)Scenarios)Moving)Forward) • Model&Structure& • Inputs& • Scenarios& • Child4Targe7ng& • Par7al&Subsidy&
• Summary&
2&
Model)Structure) Transmission&
Rx&
Infec7on& Fever& Hospitaliza7on&
Rx&
Death&
An7malarial&Drugs&Avert&Bad&Outcomes,& &&the&Timing&of&Treatment&MaKers&
Rx& 3&
Model)Structure)
Introduction of a New Drug
Doses per 100,000, per year
Deaths Averted
0
Deaths per 100,000, per year
Baseline
T0 Time (in Years)
4&
0
â—?
Frequency of Resistance
Deaths Averted
Emergence 0
Introduction of a New Drug
Deaths per 100,000, per year
Doses per 100,000, per year
1
Model)Structure) Baseline
T0 Time (in Years)
5&
â—?
Frequency of Resistance
Deaths Averted
0
Introduction of ACTs
Deaths per 100,000, per year
Doses per 100,000, per year
1
Model)Structure)
Time (in Years)
6&
10
●
1
●●●
●
●● ● ● ●● ● ●
●
●
1/100
annual FOI
Model)Structure)
a
Malaria&Transmission&by&Mosquitoes&
0.01
0.1
1
10
100
1000
3/5 1/10
b ●● ●
● ●
●● ● ● ● ●
● ●
● ●
1/500
Transmission Efficiency
annual EIR
0.01
0.1
1
10
100
1000
annual EIR
7&
Model)Structure) S&
I&
P&
Children&
S&
I&
P&
Adults&
• Two4stage&model&of&malaria&transmission& • Children&are&more&likely&to&become&clinically&ill&when&infected& • Treated&individuals&remain&uninfected&un7l&drug&clears&system&
8&
Model)Structure) IW
Drug&sensi7ve&
IS&
Drug&Resistant&(Single)& NAD,&AMT,&PMT&
ID&
Drug&Resistant&(Double)& NAD4PMT,&NAD4AMT,&ACT&
IT&
Drug&Resistant&(All)& NAD4ACT&
&
S&
Individuals&(both&children&and& adults)&can&be&infected&by&drug& sensi7ve&or&drug&resistant& parasites&
9& NAD&4&Non4Artemisinin&Drugs& AMT&4&Artemisinin&Monotherapy& PMT&4&Partner&Drug&Monotherapy&
Inputs) Death&Rates&
10& Source:&Murray,&C.&J.&L.,&L.&C.&Rosenfeld,&et& al.&(2012).&"Global&malaria&mortality& between&1980&and&2010:&a&systema7c& analysis."&The$Lancet&379(9814):&4134431
&
Inputs) Fever&Rates&
Treatment&Rates&
Ini7al&Market&Share&
Price&
Source:&CHAI&evalua7on&of&DHS&Household& Surveys
&
11&
Inputs:)Demand)Functions) Ghana
Ghana
0.015
Non-ART AMT
ACT-q ACT-n
all
100 CQ AMT
0.010
ACT-q ACT-n
0.005
0.000 0
1
2
3
4
Drug Percentages
Drug Demand
80
60
40
Price Difference of Subsidy
20
Increasing&the&subsidy& increases&the&demand&for& ACTs&as&well&as&overall& drug&demand&
0 0
1
2
3
Price Difference of Subsidy
4
12&
0.4
0.6
0.8
1.0
1
100
3
4
5
6
0.0
1.0
Price Difference of Subsidy
Tanzania
Uganda
CQ AMT
1.5
ACT-q ACT-n
80
80
ACT-q ACT-n
2 Price Difference of Subsidy
3
4
60 20 0
1
2
3
Price Difference of Subsidy 1
40
Drug Percentages
60
Drug Percentages
20 0
40
100 80 60 40 20
0
0
0.5
Price Difference of Subsidy
ACT-q ACT-n
0
Drug Percentages
100
2
CQ AMT
Nigeria
CQ AMT
60 20 0
0
Price Difference of Subsidy
100
0.2
ACT-q ACT-n
40
Drug Percentages
60 20 0
0.0
CQ AMT
80
ACT-q ACT-n
40
Drug Percentages
60 40 0
20
Drug Percentages
CQ AMT
Niger
80
ACT-q ACT-n
80
CQ AMT
Madagascar 100
100
Kenya
4
0.0
0.2
0.4 Price Difference of Subsidy
0.6
0.8
13&
Scenarios) • Child4Targe7ng& • Subsidize&child&packets&only& • Assume&different&levels&of&leakage&to&adults& • Adults&that&take&child&packs&either&“stack”&or&underdose&
• Par7al&Subsidy& • Pricing&Op7ons& • No4subsidy • Par7al&Subsidy& • Full&Subsidy&
&&
• Tiering&Op7ons& 14&
Scenarios:)Baseline) Annual&ACT&Treatments&(high&and&low&elas7city)&
Number&of&es7mated&annual&ACT&treatments&demanded& • Universal&Subsidy& • Assumes&a&propor7on& with&no&malaria& infec7ons& • Individuals&treat& • Child&doses&cost&50%& of&adults&(~$1)&
15&
Scenarios:)Baseline)
Number&of&Deaths&Averted&(high&and&low&elas7city)&
16&
Scenarios:)Baseline)
Number&of&Deaths&Averted&(high&and&low&elas7city)&
17& &
Same&as&prior&slide&–&dierent&scale
Scenarios:)Child=Targeted) Number&of&Deaths&Averted&(low&elas7city)&
18&
Scenarios:)Child=Targeted) Number&of&Deaths&Averted&(low&elas7city)&
19& &
Same&as&prior&slide&–&dierent&scale
Scenarios:)Child=Targeted) Number&of&ACT&Treatments&Demanded&(low&elas7city)&
20&
Scenarios:)Child=Targeted) Cost4Eec7veness&(low&elas7city)&
21&
Partial)Subsidy) • No&Subsidy& • Countries&have&access&to&AMFm&mechanism&to&purchase&qa4ACTs& at&nego7ated&price&(but&no&subsidy)& • Reduces&end4user&price&
• Par7al&Subsidy& • Subsidy&covers&a&por7on&(50%)&of&the&cost&of&quality4assured& ACTs,&but&not&the&full&price.&& • Results&in&larger&reduc7on&in&end4user&price&
• Full&Subsidy& • Subsidy&covers&95%&of&the&cost&of&quality4assured&ACTs& • Results&in&significant&reduc7on&in&end4user&price& 22&
Annual&Subsidy&Cost&($millions)&
Partial)Subsidy)Cost)by)Country) Low&Elas7city4Low&Ini7al&ACT&Use&
23&
Partial)Subsidy)Cost) Annual&Subsidy&Cost&($millions)&
Total&Subsidy&Cost&across&all&countries&
Low&Ini7al& ACT&Use&
Higher&Ini7al& ACT&Use&
Low&Elas7city&
Low&Ini7al& ACT&Use&
Higher&Ini7al& ACT&Use&
High&Elas7city&
24&
Cost=Effectiveness) Cost4Eec7veness&($/Death&Averted)&
Cost4Eec7veness&across&all&countries&(low&elas7city)&
Excludes:&Senegal,&Somalia,&Kenya,&Rwanda,&Zimbabwe,&Sudan,&Ethiopia,&Mauritania,&Namibia,&Swaziland,&Djibou7&
25&
Partial)Subsidy:)No)Subsidy) Deaths&Averted&(thousands)&
Deaths&Averted&over&Five&Years&(low&elas7city)&
26&
Summary) • Saving&lives&usually&comes&at&a&(diminishing&marginal)&cost:& • A&universal&subsidy&saves&the&most&lives&and&costs&the&most& • A&par7al&subsidy&or&a&child&targeted&subsidy&with&low&leakage&to& adults&tends&to&be&more&cost4effec7ve&To&maximize&the&number& of&lives&saved&
• To&maximize&the&number&of&lives&saved:& • Expand&access&to&drugs&purchased&at&the&AMFm&nego7ated&price.&& Reduces&risk&of&leakage&across&borders,&lower&nego7ated&prices& and&improve&access&to&QA4ACTs.& • Tailor&AMFm&to&county&needs:&Spend&$$&on&countries&that&give& the&biggest&bang&for&buck&–&whether&on&child&targeted&subsidy&or& par7al&subsidy&depending&on&local&context.& 27&