[e-drug] Artemether/lumenfantrine - pack sizes, brand name issue

["rob verhage" <verhager@cq-link.sr>]

E-DRUG: Artemether/lumenfantrine - pack sizes, brand name issue
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Dear e-druggers,

It is already some years ago that I laid my eyes for the first time on artemether/lumenfantrine 20/120mg tablets presented in four different package forms with the brand name Coartem in relatively big letters on each package form. It was presented as, if I am not mistaken, product(s) especially developed for the public health sector by Novartis following an agreement with WHO. Please correct me if I am wrong. At the time, my first reaction was that there was something wrong with Coartem, but did not give it much further thought. However, recently I was requested to look into the procurement and management supply aspects of the introduction of artemether/lumenfantrine 20/120mg tablets in Uganda and this time I did study the issue more closely. I like to share with you the following questions that came up:

1. Is it not so, that with Coartem being marketed in four different products (package forms, colours and users instructions) that, in fact, one and the same tablet is being marketed as four different products? And that this way quantification, procurement, logistics and dispensing are being made more complicated than if it was packed as one product? And with extra costs for the packaging, storage space and transport?
2. Are we not suppposed to "talk generic" and avoid the use of brand names?

When I discussed these issues with some colleagues, their first reaction was that the different package forms may increase patient compliance. I searched the web , but could not find any studies to confirm this. On the contrary, in anecdotal cases health workers in the field denied such an effect. And with one or more of the four different package forms out-of-stock (which was the case most of the time in Uganda) the available ones are being divided in order to service all patients and this practice defeats any intention for possible better patient compliance anyway (in this case some patients have to be told to ignore the pre-printed instructions). Is there any e-drugger that knows about serious studies that proof better patient compliance due to Coartem?

I would plead for the introduction of the generic artemether/lumenfantrine 20/120mg tablets to be packed in blisters with 6 tablets each in cartons with 100 or more blisters. This way having one product that can be used for all four different age classes. 

What are the experiences of the other e-druggers? Are the issues mentioned above serious enough to take some form of action?

Best regards,

Rob Verhage
Pharmacist
HERA Consultant
PO Box 4002
Paramaribo
Suriname
597 8561109
verhager@cq-link.sr