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[e-drug] Artemether/lumefantrine (AL) - pack sizes, brand name issue (10)

E-DRUG: Artemether/lumefantrine (AL) - pack sizes, brand name issue (10)
[A mistake of your moderator caused a delay in this posting for 2 weeks - 
sorry. WB]

Dear e-druggers,

Thanks for your reactions on my posting dated 22 July 2007 regarding "[e-drug] 
Artemether/lumefantrine (AL) - pack sizes, brand name issue"

I received 11 reactions of which 7 posted through e-drug. In Uganda, the 
discussion continues and it would be appropriate to inform e-drug in due time.

According to my interpretation all agreed with the following:

1. The current packing of one and the same tablet (AL 20/120mg) as Coartem in 4 
package forms complicates the  procurement and logistics

2. This packing is increasing the costs of AL tablets as well as the costs for 
handling of AL tablets

3. There is no evidence for better patient compliance for Coartem packed in 
four package forms compared to one package form.

4. On the contrary, practice shows that dispensing and use are more complicated 
(confusion among staff and because of the frequent stock-outs of one or more of 
the four package forms)

5. We should talk generic and avoid the use of the brand name Coartem  (it 
seems Cipla has introduced a brand name of its own, i.e. Lumet, with similar 
package forms, is this correct?

One suggestion was to use tins of 1000 tablets. This is not possible due to the 
hygroscopic characteristics of the tablets. The tablets do need to be packed in 
blisters or strips. In Namibia, a sole package form of 24 tablets with a 
tearing line after each 6 tablets is being used. It would be interesting to 
hear who the manufacturer/supplier is. 

One of the reactions emphasized the importance of the balance between 
distribution aspects, pharmaceutical care with "prime the convenience at 
patient care level" (I hope I summed this up in a correct way). I agree, but 
want to ask if this should not have been considered before introducing a new 
way of packaging? No evidence has been provided that this was done before 
Coartem was introduced.

Novartis reaction on 3 August 2007 has not convinced me for the following 

1. Not one of the opinions expressed are being supported by evidence. The ones 
who take the effort to check the two references given will discover that the 
statement "The effectiveness has been validated during rigorous field testing 
of the current presentation." is not supported in these publications. None of 
the two articles contains evidence for improved patient compliance due to 
Coartem packaging compared to a single packaging form. 

2. Novartis' reaction regarding costs is an attempt to divert the discussion 
from the real issue at stake. The issue is the cost difference between the 
current packaging forms for Coartem and one packaging form (for example, rolls 
of blisters with tearing line for strips with 6 tablets each or even for the 
Novartis' presentation in the private sector Riamet that comes in the form of 3 
strips of 8 tablets each per box). It should be rather easy for Novartis to 
show us the difference in production costs for Coartem and Riamet.

3. Finally, almost 30 years of proven success of Essential Medicines Policy are 
being disregarded (disrespected?) by Novartis by using the argument of 
recognition of the producer for its promotion of the brand name Coartem: "to 
identify the producer of the product in order to be assured of good quality". 
It seems that in this case the Novartis' opinion is that the producer comes 
before the patient?

As far as I could establish, among the reactions were none from WHO or Roll 
Back Malaria. For the sake of balance of opinions, it would be interesting to 
get their input.

Kind regards,

Rob Verhage
HERA Consultant
PO Box 4002
+597 8561109

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