Table 1

Full list of references with cost implications from programmes

Author and yearLevelCountry/regionInterventionOutcome measureResults
Comprehensive drug system policy
Chaudhury et al15 (2005)SubnationalIndiaEvaluation of a comprehensive drug policy in Delhi which included development of an Essential Drugs List, a centralised pooled procurement system, and activities to promote rational drug useTotal savings to the Government of Delhi from drug purchasesApproximately 30% cost savings
Homedes, and Ugalde13 (2006)NationalBrazilMultiple interventions by the Ministry of Health, including promotion of multisource drugs, the development of the Brazilian pharmaceutical industry and the use of provisions of the TRIPS agreements to engage in aggressive price bargaining with multinational pharmaceutical manufacturersAnnual cost per person of ARV treatmentCosts reduced from US$4860 in 1997 to US$2530 in 2001 (48% reduction) and to about US$1000 in 2003 (60% reduction, for a total reduction of 79% in 6 years)
Li et al14 (2013)NationalChinaEvaluation of the National Essential Medicines Scheme, which included a National Essential Drugs List, a grassroots zero-mark-up policy, reimbursements for drugs on the list and public procurement of drugsTotal cost of drugs in select districts for treating (1) pneumonia or bronchitis, and (2) gastroenteritisCosts decreased by 17.5% for patients with pneumonia (p<0.05) and 48.4% for patients with gastroenteritis (no significance figure reported)
Centralised procurement/tender
Adesina et al21 (2013)NationalMexicoEvaluation of the Mexican Commission for Price Negotiation on the price of ARV drugsCost savings from negotiation process for 12 ARV drugs38% reduction in total spend on ARV drugs (but prices still above those in other upper-middle-income countries)
Alabbadi19 (2011)NationalJordanJPD of Jordan bids for four government agencies and aims to unify purchases of drugs and medical supplies to reduce the cost of purchased drugsSavings from joint purchasing for all drugs in first year of JPD5.2% savings achieved; 17% savings reported when one drug (cephalexin), whose raw material prices doubled that year, excluded from analysis
Al-Abbadi et al20 (2009)NationalJordanEstablishment of a joint procurement system across four different government agenciesTotal savings to the four agencies8.9% reduction in spend on drugs using joint procurement system
Amaral and Blatt24 (2011)SubnationalBrazilIntermunicipal Health Consortium used to procure drugs for multiple municipalities after a government policy decentralising procurement to the municipality levelNumber of drugs with reduced unit prices76% of drugs had a reduction in unit price within 2 years of programme implementation
Chaumont et al22 (2015)NationalMexicoCreation of the Coordinating Commission for Negotiating the Price of Medicines (CCNPM) to negotiate prices for drugs, especially ARVsAnnual treatment cost for various ARVs in Mexico compared to HICs, UMICs, and LMICsARV prices were ‘higher than those paid by similar upper-middle income countries’ and were higher than prices in HICs in some cases
Danzon et al49 (2015)InternationalBrazil, China, Algeria, Egypt, India, Indonesia, Philippines, Thailand, South Africa, and French West AfricaTendered procurement by NGOs for cardiovascular and anti-infective drugs (including HIV and TB drugs) in LMICsComparison of retail originator drug prices to tendered originators and tendered generic drugsPrice for tendered originators was 42.4% less than the price for retail originators; price for tendered generics was 66.8% less than the price for retail originators
DeRoeck et al16 (2006)*InternationalBahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab EmiratesGCC group purchasing programme which centralised tender and two times a day processesSavings on price for vaccines procured through the group purchasing programme4–46% price reduction on six vaccines
DeRoeck et al16 (2006)*InternationalLatin AmericaPAHO EPI Revolving Fund, which purchases vaccines and immunizations on behalf of countries in Latin America and the CaribbeanSavings on price for vaccines procured through Revolving Fund vs those supplied directly to countries before creation of the fund70–82% price savings on vaccines and immunisations
Ewen et al9 (2014)InternationalPalestine (Gaza/The West Bank), Jordan, Lebanon, SyriaComparison of different procurement mechanisms for drugs by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA); analysis of price differences when drugs procured using central tender vs locally by each field sitePrices of medicines including antidiabetic medicines, antimicrobials, antihypertensives and antipyreticsSyria paid 20% less for drugs procured locally; Lebanon paid 83% more for drugs procured locally and West Bank paying 128% more for drugs procured locally
Gomez-Dantes et al23 (2012)NationalMexicoIntroduction of the Coordinating Commission for Negotiating the Price of Medicines and other health inputs (CCPNM) in 2008Annual direct savings on public expenditure for public medicines since introduction of CCPNMAnnual savings from US$52.1 million—US$121.8 million in the first four years of CCPNM
Huff-Rousselle and Burnett18 (1996)InternationalCaribbeanECDS, which provides pooled procurement services to nine small island nationsAverage savings on drugs procured through ECDS after first tender cycle16.1–66.1% savings across different countries
Khoja and Bawazir17 (2005)InternationalBahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab EmiratesGroup purchasing agreement among six countries via the GCCTotal cost savings to member countries‘According to a study performed by GCC Executive Offices in 1992, total of US$33 million was saved by the five GCC states. Furthermore, more than US$11 million was saved by 3 GCC states in 2001.’
Milovanovic et al25 (2004)SubnationalSerbiaEvaluation of a drug tender process of 479 drug formulations by a university hospitalCost savings compared to free market price17.2% cost savings from drug tender compared to free market price for basket of drugs purchased
Sigulem and Zucchi26 (2009)SubnationalBrazilE-procurement tool used to facilitate joint purchasing of medications by multiple hospitals within a networkChange in unit price of drugs from (1) before joint purchasing to beginning of joint purchasing, and (2) from beginning of joint purchasing to last joint purchase over 2-year periodOf 37 drugs included, 34 showed price reductions after implementation of e-procurement system, and 27 showed further decreases in price over the following 2 years
Supply chain management
Hamel et al50 (2015)SubnationalNigeriaProgramme to strengthen laboratory services in hospitals and clinics, with procurement of more efficient equipment, laboratory modifications, supply chain management and trainings; programme involved securing reduced reagent costs due to high volume of regular laboratory testsReduction in cost/test for specific testsCD4+ cell count test reduced from US$22/test to US$2/test; routine chemistry tests (such as alanine aminotransferase) reduced from >US$1/test to US$0.29/test; viral load tests reduced from US$33/test to US$14/test
Lloyd et al (2015)51SubnationalTunisiaModification of methods to store and transport vaccines, including the use of electric utility vehicles for regular deliveriesEnergy costs for storage and distribution of vaccines20.16% reduction in costs after implementation of supply chain improvements
Riewpaiboon et al27 (2015)NationalThailandTransition to VMI system to manage vaccine supply chainTotal cost per dose of vaccine procuredCosts increased from US$1.35 (conventional system) to US$1.43 (VMI)
Bevilacqua et al10 (2011)SubnationalBrazilStudy of the impact of requiring bioequivalence and/or bioavailability studies as part of the procurement of generic medicinesChange in total procurement cost of the same quantity of 150 medicines before and after the policyTotal costs increased by 87% after implementation of the policy because test failure rates increased from 2.6% before the policy to 56.9% after the policy
Maiga et al38 (2003)SubnationalMaliComparison of city (Niono) where public health system regularly supplies drugs with another city (Koutiala) where public health system does not supply drugs, limiting supply to availability in private sectorCost of drugs to consumers after accounting for the content of transactions (ie, type and quantity of drugs)Drugs cost 32% less in city where public health system supplied drugs
Ramani39 (2006)SubnationalIndiaImplementation of a reengineered, IT-enabled system to purchase hospital suppliesCost to purchase common items7.7% reduction in cost of purchase for common items after implementation of system
Thuray et al40 (1997)NationalSierra LeoneProcurement of drugs and supplies directly from commercial supplier, rather than through standard governmental channels, by a PMM team under the Ministry of Health and with external partner supportReduction in total costs for drugs and supplies associated with select obstetric procedures in conditions (comparison between PMM costs vs hospital pharmacy costs)28% price reduction for treating sepsis/induced abortion (non-surgical); 30% price reduction for treating eclampsia; 49% price reduction for obstetric surgery; 54% price reduction for treating postpartum haemorrhage
Tougher et al36 (2012)InternationalGhana, Kenya, Madagascar, Niger, Nigeria, Uganda, and TanzaniaEvaluation of the AMFm, which included price reductions through negotiations with manufacturers of QAACTs; a buyer subsidy, via a copayment by the Global Fund to participating manufacturers, for purchases made by eligible public, private and non-governmental organisation importers; and interventions to support AMFm implementation and promote appropriate antimalarial useManufacturer price of QAACTs sold to private, for-profit buyers; median price of QAACTs sold in the private, for-profit sectorManufacturer price reduced 29–78% depending on package size; Median price to consumers dropped in all seven pilot countries, with a statistically significant drop (p<0.0001) for five of seven countries
Witter (2007)52SubnationalSudanRDF which oversees procurement, distribution and sale of drugsPrices of drugs for its list of essential drugsDrugs 40% cheaper than CMSPO and 100% cheaper than private sector outlets
  • *Note that these entries refer to the same citation, which reports results from two different programmes.

  • AMFm, Affordable Medicines Facility-malaria; ARV, antiretroviral treatments; CCNPM, Coordinating Commission for Negotiating the Price of Medicines; CMSPO, Central Medical Supplies Public Organisation; ECDS, Eastern Caribbean Drug Service; EPI, Expanded Programme on Immunisation; GCC, Gulf Cooperation Council; HICs, high-income countries; JPD, Joint Procurement Directorate; LMICs, low-income and middle-income countries; PAHO, Pan-American Health Organization; PMM, preventing maternal mortality; QAACTs, quality-assured ACTs; RDF, revolving drug fund; UMICs, upper-middle income countries; VMI, vendor managed inventory.