A meta-analysis of substandard and falsified essential medicines and the economic burden they pose on low- and middle-income countries revealed that the impact of poor-quality medicines is an understudied problem requiring further vigorous economic analyses, according to a study published in JAMA Network Open.
The authors of this systematic review and meta-analysis sought to estimate the prevalence of economic and health consequences of substandard and falsified essential medicines in low- and middle-income countries by analyzing existing evidence.
The researchers searched 5 databases (PubMed, EconLit, Global Health, Embase, and Scopus) for relevant articles that examined medication quality, the prevalence of substandard and falsified medicines, and whether the use of poor-quality medicines created an economic burden on low- and middle-income countries. Multiple independent reviewers were responsible for data extraction as well as for assessing study quality using the Medicine Quality Assessment Reporting Guidelines.
Investigators systematically reviewed 96 studies that estimated the prevalence of poor-quality medicines and tested at least 50 samples using adequate methods. Across all low- and middle-income countries included in the analysis, the average overall prevalence of substandard and falsified essential medicines was 13.6% (95% CI, 11.0%-16.3%). Most of the study data focused on the regional prevalence of poor-quality medicines in Africa (18.7%; 95% CI, 12.9%-24.5%) and Asia (13.7%; 95% CI, 8.2%-19.1%). The distribution of substandard and falsified essential medicines was most prevalent among antimalarial medications (19.1%; 95% CI, 15.0%-23.3%) and antibiotics (12.4%; 95% CI, 7.1%-17.7%). Approximating the economic burden of using poor-quality essential medicines, 8 studies reported estimates ranging from $10 billion to $200 billion.
The economic studies focused primarily on market size. It is important to note that crude or undisclosed methods were used in deriving economic estimates, resulting in poor quality and large heterogeneity of available data. Further limitations of the analysis included publication bias that lead to differences in study quality, sampling, purchasing, and data collection methods related to medicine categories or region.
The authors concluded that substandard and falsified essential medicines are a substantial threat and represent an understudied problem with a significant gap in literature on the economic burden of poor-quality medicines. Robust economic analyses are needed to capture the broader economic burden of substandard and falsified essential medicines, to raise awareness, and to develop improved strategies for intervention.
Ozawa S, Evans DR, Bessias S, etc. Prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries: a systematic review and meta-analysis [published online August 10, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.1662