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.