Lessons learned from the Global Fund’s Price and Quality Reporting (PQR) database T Patrick Aylward, Sophie Logez, Thuy Huong Ha, Monika Zweygarth, Carmen.

Lessons learned from the Global Fund’s Price and Quality Reporting (PQR) database

T Patrick Aylward, Sophie Logez, Thuy Huong Ha, Monika Zweygarth, Carmen Perez Casas, Luca Li Bassi

Major Topics

• Key Challenge: Data Quality

• Overview of the dataset

• Price Benchmarking at the Global Fund

Why is this important?

• Pharmaceutical and Health Products ~ 40% of expenditure.

• Increasing emphasis on value for money

Health Products and Health Equipment; 19.8%

Medicines and Pharmaceut-ical Products; 19.0%

Human Resources; 14.4%Training; 10.2%

Infrastructure and Other Equipment; 8.7%

Living Support to Clients/Target Population; 5.1%

Planning and Administration; 5.2%

Monitoring and Evaluation; 4.1%

Communication Materials; 4.4%

Procurement and Supply Management Costs; 3.2%

Overheads; 2.8%

What is Price and Quality Reporting?

• A web-based system for tracking the purchases of key pharmaceutical and health products

• Transactional data entered by Principal Recipients upon receipt of goods and verified by Local Fund Agents.

• PQR contains US$ 2.09 billion1 of procurement data from 119 countries from 2009 - 2011

1 Value of goods reported to the PQR as of 08 November 2011

What is Price and Quality Reporting?

• Reporting is mandatory for six product categories:1. antiretrovirals,

2. antimalarial medicines,

3. anti-tuberculosis medicines,

4. bednets,

5. condoms,

6. rapid diagnostics tests for HIV and malaria

• All data is publicly available & updated every 24 hrs: http://www.theglobalfund.org/en/procurement/pqr/

• Data will be fed into the WHO Global Price Reporting Mechanism (~25% of data)

Key Challenge: Data Quality• 700+ users in 119 countries reporting data

• High turnover and little training

• User interface wasn’t acceptable to our customers

• No dedicated resources to monitoring and governing data

• Low data quality that prevented system from being used as an operational tool

• In 2010, the Global Fund overhauled the system to improve data quality and usability of the system

Key Challenge: Data Quality• Extreme outliers decreased substantially

• The new PQR meets or exceeds the expectations of 83% of in-country users

• 81% of PR respondents agreed with the statement “The PQR is a useful tool that helps me in my job.”

The Dataset• US$ 2.09 billion1 of procurement data from 119 countries covering

procurement transactions

1 Value of goods reported to the PQR as of 08 November 2011

Category Cost (USD) %Total

Bednet $889 M 42.5%

Anti-Retroviral $776 M 37.1%

Anti-malaria medicine $142 M 6.8%

Anti-TB medicine $132 M 6.3%

Diagnostic test $117 M 5.6%

Condom $37 M 1.8%

Grand Total $2,093 M 100%

The Dataset• Used to track trends, facilitate analysis and provide insight into

market dynamics

2007 2008 2009 2010 H1 2011

0

50

100

150

200

250

300

350

193

162

125104 100

Reported unit costs of common first line ARV Reg-imens

d4T+3TC+NVP (FDC)

d4T+3TC+EFV

AZT+3TC+NVP (FDC)

AZT+3TC+EFV

Basket of FL re-gimens

Vo

lum

e W

eig

hte

d M

edia

n

(US

$ p

er p

atie

nt

per

yea

r)

2008 2009 2010 20110

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

0.00

1.00

2.00

3.00

4.00

5.00

6.004.94

4.63 4.45 4.39

Quantity

Weighted Median Cost

The Dataset• Used to track trends, facilitate analysis and provide insight into

market dynamics

Adult ARVs delivered to recipients in 2009 and 2010

The Dataset• Encouraging recipients to compare prices against references and

other countries

Price Benchmarking Global Fund Grants• 2010 ARV prices generally at or below international reference sources

Product Name StrengthMSF UTW: Lowest PQ

CHAI Ceiling

Median 75th Perc 90th Perc 2010 SalesNumber of Countries

Lamivudine + Nevirapine + Zidovudine - FDC 150mg+200mg+300mg $137 $140 $132 $135 $144 62,014,440$ 34

Lamivudine + Nevirapine + Stavudine - FDC 150mg+200mg+30mg $67 $79 $61 $64 $69 50,254,981$ 30

Lamivudine + Zidovudine - FDC 150mg+300mg $110 $110 $99 $103 $126 34,409,685$ 63

Efavirenz (EFV) 600mg $61 $75 $54 $62 $101 25,322,109$ 68

Lopinavir (LPV) + Ritonavir (RTV) - FDC 200mg+50mg $486 $440 $446 $468 $1,000 17,794,464$ 58

Emtricitabine + Tenofovir - FDC 200mg+300mg $143 $140 $139 $141 $141 12,734,522$ 27

Lamivudine + Tenofovir - FDC 300mg+300mg $107 $110 $108 $113 $132 9,960,938$ 13

Nevirapine (NVP) 200mg $34 $37 $32 $33 $39 7,179,176$ 53

Efavirenz + Emtricitabine + Tenofovir - FDC 600mg+200mg+300mg $219 $229 $242 $242 $242 4,506,762$ 9

Abacavir (ABC) 300mg $207 $222 $198 $219 $231 3,990,559$ 46

Tenofovir (TDF) 300mg $85 $87 $181 $226 $229 3,624,626$ 42

Lamivudine (3TC) 150mg $33 $32 $32 $43 $43 3,531,537$ 45

Lamivudine + Stavudine - FDC 150mg+30mg $42 $36 $39 $43 3,184,909$ 29

Efavirenz + Lamivudine + Tenofovir - FDC 600mg+300mg+300mg $200 $208 $208 $208 3,130,075$ 4

Zidovudine (AZT or ZDV) 300mg $91 $93 $82 $89 $98 2,725,196$ 41

PQR (Volume Weighted)

Price Benchmarking Global Fund Grants

Source: PQR Downloaded 27 Sept 2011. South Africa data removed from analysis.-Médecins Sans Frontières. Untangling the Web of Antiretroviral Price Reductions. 13th ed. Campaign for Access to Essential Medicines; July 2010. Available from: http://utw.msfaccess.org/downloads/11

Price Benchmarking Global Fund Grants

• Transactions benchmarked against range of historical international reference prices at the time of purchase order

• Two Key measures: Price Ratio & Cost Above/Below Reference

• Indicators can be aggregated to the product, recipient, grant, country level

• Price benchmarking a routine part of grant reviews

Condition Price Ratio Cost Above/Below Reference

Actual price < reference range

Actual price / lower bound of range

At least: US$: (Actual price – lower bound)*qty

Cost below reference

Actual price falls within reference range

1.0 US$ 0

Actual price > reference range

Actual price / upper bound of range

At least: US$: (Actual price – upper bound)*qty

Cost above reference

Price Benchmarking Global Fund Grants

Example: Country A

Product Name Total Product Cost (USD)

Reference Price Ratio Cost above reference

Efavirenz (EFV) $ 6,510,468 0.77 -$ 1,951,134

Efavirenz + Lamivudine + Tenofovir - FDC $ 700,000 1.09 $ 58,124

Lamivudine (3TC) $ 289,926 0.87 -$ 44,827

Lamivudine + Nevirapine + Stavudine - FDC $ 13,755,718 0.82 -$ 2,947,680

Lamivudine + Nevirapine + Zidovudine - FDC $ 22,551,079 0.95 -$ 1,185,731

Lamivudine + Zidovudine - FDC $ 14,906,927 0.95 -$ 779,353

Nevirapine (NVP) $ 1,675,272 1.00 $ -

Stavudine (d4T) $ 423,500 0.91 -$ 40,513

Grand Total $ 60,812,890 0.89 -$ 6,891,115

Next Steps

Next Steps

• Better reports for PRs

Next Steps

Conclusions

• The PQR is a public good and is becoming a useful tool to procurement practitioners as well as researchers

• The PQR helps the Global Fund ensure value for money and has helped to bring transparency to the market

• The vast majority of ARVs procured in 2010 were purchased at prices either at or below international reference ranges or in line with originator tiered schemes

• Data challenges remain and users need to be cautious about context and comparing like to like

QUESTIONS

Key Challenge: Data Quality• Extreme outliers decreased from 15-20% of data points data points to

4-6% of data points,• The new PQR meets or exceeds the expectations of 83% of PR & LFA

respondents (up from 40%),• 81% of PR respondents agreed with the statement “The PQR is a

useful tool that helps me in my job.”

PQR Version 3.6 PQR Version 4.0

Price Benchmarking Global Fund Grants

Source: PQR Downloaded 27 Sept 2011. South Africa data removed from analysis.-Management Sciences for Health. International Drug Price Indicator Guide (accessed 1 September 2011); July 2010. Available from: http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=english.