Quality and Cost-Effectiveness in Pharmaceutical Procurement: Strategies and a Systematic Review
Abstract
Background: Pharmaceutical procurement is a critical function of the healthcare system in ensuring public health, medicine security, and fiscal sustainability. Inefficient procurement bears the triple risk of essential medicine stockouts, infiltration of substandard drugs, and a tremendous waste of funds, making it a persistent challenge to balance quality-assured access with cost-effectiveness.
Aim: This review synthesizes and assesses the evidence from 2015 to 2024 about strategies and frameworks tested to improve the quality assurance and cost-effectiveness of public sector pharmaceutical procurement.
Methods: The following databases - PubMed, Scopus, Web of Science, and EMBASE - were systematically searched for peer-reviewed studies, with relevant keywords, between the period of 2015 and 2024. Included empirical studies, reviews, and case studies from various income settings were thematically analyzed via narrative synthesis.
Results: The evidence highlights a toolkit of interlinked strategies. On cost-effectiveness, pooled procurement mechanisms, such as national/regional tenders, attained substantial price reductions (15-40%), whereas stringent generic medicine policies formed the foundation for cost containment. For quality, a tight suppliers' pre-qualification, reliance on WHO/ Stringent Regulatory Authorities, and post-market surveillance were indispensable features. Certain integrated strategies, such as Quality-assured Framework Agreements, came out successful in accommodating both objectives. Main barriers to implementation included political interference, insufficient workforce capacity, and fragmented information systems.
Conclusions: A holistic, multi-pronged approach is needed, recognizing procurement as strategic in scope, not just an administrative function. Recommendations range from institutionalizing open, data-driven decision-making to investing in workforce capacity, designing quality-weighted tenders, and integrating digital tools. Future studies could focus on the longitudinal impact on health and specific anti-corruption frameworks.
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Authors
Copyright (c) 2025 Mohammed Ali Alahmar, Fatimah Ali Ahmad Shabi, Noura Hassan Mohammed Safi, Amal Saleh Adam Faraj, HAssan Shabi alagedi, Masaad Awadh Almutairi, Huda Omar Salhia, Ebtisam Ali Aljaizani, Sulaiman Qaem Alanazi, Sultan Saad alshehri, Ahmad Abdullah Alkaabi, Houson Ali Aloudah, Muneerah Suliman Al-Doukhi, Ghazyah Nasser ALquraini, Abdulaziz Sayer Alanazi
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