Nearly a million people die from malaria each year because they can’t afford the most effective treatment and instead often buy old drugs to which the malaria parasite has become resistant, according to a study of six high-risk nations by Populations Services International Malaria, Reuters writes.

Artemisinin combination therapy, or ACT, drugs made by firms such as Novartis and Sanofi-Aventis can cost as much as 65 times the daily minimum wage in some African countries. The meds can cost up to $11 to patients buying over the counter, while older drugs to less effective drugs cost just $0.30 cents.

“With most people accessing anti-malarial medication through the private sector, price becomes a critically important barrier,” PSI director Desmond Chavasse tells Reuters. “A full course of an adult treatment of ACT can be up to 65 times the minimum daily wage.”

The study, which was designed to provide baseline data to allow experts to judge a planned drug subsidy scheme being offered in 11 nations, looked at availability, pricing and volumes for 23,000 malaria treatments sourced from 20,000 outlets, Reuters reports. In most countries, ACTs make up only 5 to 15 percent of the total volume of anti-malarials on the market, it found.

According to PSI, the majority of malaria endemic countries changed their treatment policies about three years ago to favour giving ACT drugs in the face of widespread malaria resistance to older monotherapy medicines. But Chavasse said despite this, ACT availability can still be as low as 20 percent in public sector health clinics.

UPDATE: On Nov. 9, a Novartis spokeswoman writes us the following statement: “Tens of thousands of malaria patients die each year because the healthcare delivery systems in African nations only reach part of the population and are often deficient, and procurement procedures take far too long. Effective malaria drugs such as Novartis’ Coartem and Coartem Dispersible are available at a low price for the public sector, but unfortunately countries do not always ensure these treatments are accessible to patients.

Novartis wants to drive access for patients to life-saving therapy and has the capacity to provide 100 million Coartem treatments per year if orders are placed in a timely manner. This capacity was never fully used last year as only 74 million treatments were ordered and delivered. To further access, Novartis has recently reduced the public sector price to USD 0.76, bringing the price of the lowest dose of Coartem Dispersible for babies and children up to 15kg to just USD 0.36. The new price reduction and savings option will hopefully encourage countries to place their orders quickly and efficiently which should improve availability of ACTs at the country level.

Since 2001, Novartis has delivered over 280,000,000 treatments to date without profit to patients in the developing world, helping to save an estimated 700,000 lives. Coartem is Novartis’ most widely-used drug in terms of the number of patients who take it each year. It is our hope that effective ACTs like Coartem and Coartem Dispersible are available to everyone in need.”