Abstract
BackgroundIn many low-income countries, the private commercial sector plays an important role in the provision of malaria treatment. However, the quality of care it provides is often poor, with artemisinin combination therapy (ACT) generally being too costly for consumers. Decreasing ACT prices is critical for improving private sector treatment outcomes and reducing the spread of artemisinin resistance. Yet limited evidence exists on the factors influencing retailers’ pricing decisions. This study investigates the determinants of price mark-ups on anti-malarial drugs in retail outlets in Cambodia.MethodsTaking an economics perspective, the study tests the hypothesis that the structure of the anti-malarial market determines the way providers set their prices. Providers facing weak competition are hypothesized to apply high mark-ups and set prices above the competitive level. To analyse the relationship between market competition and provider pricing, the study used cross-sectional data from retail outlets selling anti-malarial drugs, including outlet characteristics data (e.g. outlet type, anti-malarial sales volumes), range of anti-malarial drugs stocked (e.g. dosage form, brand status) and purchase and selling prices. Market concentration, a measure of the level of market competition, was estimated using sales volume data. Market accessibility was defined based on travel time to the closest main commercial area. Percent mark-ups were calculated using price data. The relationship between mark-ups and market concentration was explored using regression analysis.ResultsThe anti-malarial market was on average highly concentrated, suggesting weak competition. Higher concentration was positively associated with higher mark-ups in moderately accessible markets only, with no significant relationship or a negative relationship in other markets. Other determinants of pricing included anti-malarial brand status and generic type, with higher mark-ups on cheaper products.ConclusionsThe results indicate that provider pricing as well as other key elements of anti-malarial supply and demand may have played an important role in the limited access to appropriate malaria treatment in Cambodia. The potential for an ACT price subsidy at manufacturer level combined with effective communications directed at consumers and supportive private sector regulation should be explored to improve access to quality malaria treatment in Cambodia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0737-9) contains supplementary material, which is available to authorized users.
Highlights
In many low-income countries, private commercial providers play an important role in the provision of malaria treatment [1,2,3,4,5,6]
By 2009, most countries with P. falciparum had switched to artemisinin combination therapy (ACT) as their first-line medicine, with the choice of combination drugs based on their efficacy in specific countries
The therapeutic life of ACT is, threatened by resistance to artemisinins confirmed on the CambodiaThailand border and more recently detected in two other countries in the Greater Mekong subregion, Myanmar and Vietnam [9]
Summary
In many low-income countries, the private commercial sector plays an important role in the provision of malaria treatment. The therapeutic life of ACT is, threatened by resistance to artemisinins confirmed on the CambodiaThailand border and more recently detected in two other countries in the Greater Mekong subregion, Myanmar and Vietnam [9]. This is of major concern to the international community, as resistance may spread to countries with much higher disease burdens in Africa, as has been the case in the past for older anti-malarial drugs [10,11,12,13,14]. The loss of ACT to resistance would be catastrophic for malaria control strategies as no other treatment with the same efficacy and tolerability is currently available [15]
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