Interventions to combat or prevent drug counterfeiting: a systematic review

Area of Science:

• Pharmacovigilance and Drug Safety
• Public Health Interventions
• Health Systems Research

Background:

• Drug counterfeiting poses significant public health risks.
• A systematic review is crucial to evaluate interventions aimed at preventing counterfeit drugs.
• Previous research has not comprehensively assessed the effectiveness of various anti-counterfeiting measures.

Purpose of the Study:

• To systematically review and synthesize evidence on the effectiveness of health system-level interventions in combating or preventing drug counterfeiting.
• To identify which interventions are most successful in reducing the prevalence of counterfeit medicines.
• To provide evidence-based recommendations for policymakers and stakeholders.

Main Methods:

• A comprehensive search of electronic databases and grey literature was conducted up to March 2014.
• Study selection, data abstraction, and risk of bias assessment were performed independently by two reviewers.
• Included studies comprised randomized trials, non-randomized studies, and case studies, with outcomes focused on drug quality and counterfeit prevalence.

Main Results:

• Low-quality evidence indicates that drug registration (OR=0.23) and WHO prequalification (OR=0.06) significantly reduce counterfeit and substandard drugs.
• Licensing of drug outlets showed low-quality evidence of probable ineffectiveness (OR=0.66).
• Multifaceted interventions showed promise, while 'two extra inspections' had no effect on drug quality (moderate-quality evidence).

Conclusions:

• Drug registration and WHO prequalification are recommended interventions for policymakers to combat counterfeit medicines.
• Multifaceted interventions should also be considered, though their effectiveness requires further high-quality evidence.
• Future research should focus on methodologically rigorous studies to address current evidence limitations.