Drugs for STD management in developing countries: choice, procurement, cost, and financing.

Area of Science:

• Global health
• Pharmacoeconomics
• Infectious disease epidemiology

Background:

• Sexually transmitted infections (STIs) pose a significant global health burden.
• Effective management of STIs relies on accessible and affordable medications.

Purpose of the Study:

• To compare the acquisition costs of drugs for standardized STI episodes across 15 countries.
• To identify factors contributing to cost variations, including treatment protocols, purchasing policies, procurement systems, and financing.

Main Methods:

• Compiled national STI guidelines, purchasing mechanisms, and drug acquisition costs from 15 countries.
• Calculated acquisition costs per episode for four main STI syndromes: urethral discharge, vaginal discharge, lower abdominal pain, and genital ulcer disease.
• Analyzed cost variations based on drug choice, procurement methods, and public vs. private sector pricing.

Main Results:

• Acquisition costs per STI episode varied significantly, ranging from 0.40 to 7.89 European currency units (ecu).
• Countries using only generic drugs had lower acquisition costs (0.54–1.07 ecu).
• Procurement methods and markups led to substantial cost differences, with private pharmacies being significantly more expensive than public sectors.

Conclusions:

• Antimicrobial resistance in Neisseria gonorrhoeae and Haemophilus ducreyi threatens sustainable STI drug supply due to higher costs of patented alternatives.
• Optimizing management protocols and improving procurement can minimize drug costs, especially when generic options are available.
• Continued donor support is crucial for low-income countries to ensure access to effective STI management.