Introduction: Increasing expenditure on pharmaceuticals has prompted many authorities,
mostly in high-income countries, to deploy pharmacoeconomic analysis as a tool to guide
formulary decision-making. However, the role of pharmacoeconomics in low-income
countries is less well known, notwithstanding an extreme scarcity of healthcare resources.
This study aims to assess the role of pharmacoeconomics in formulary decision-making and
to generate economic evidence for anti-malarial drugs in Tanzania.
Methods: The thesis consists of four sub-studies, which were conducted using four
different methodologies. Paper I is a systematic review study which describes the status of
pharmacoeconomic analysis studies and their influence in formulary decision-making
processes. Paper II is a qualitative case study about national formulary decision-making
processes, the criteria used, and the underlying sources of evidence. Data was collected via
in-depth interviews with key informants and document reviews and the analysis was done
thematically. Paper III uses a Markov decision-model to compare the cost-effectiveness of
dihydroartemisinin-piperaquine (DhP) and artemether-lumefantrine (AL) for the treatment of
uncomplicated malaria in children, from the provider's perspective. Cost data was collected
at a public district hospital located in an urban area. Paper IV uses a dynamic Markov
decision-model to predict the budget impact on drugs and diagnostics when DhP is used as
a first- or second-line drug to treat uncomplicated malaria in children. Probabilistic sensitivity
analyses were used to test the robustness of model results.