Affordability of adult HIV/AIDS treatment in developing countries: modelling price determinants for a better insight of the market functioning

Abstract

IntroductionThis study aims to provide a landscape of the global antiretroviral (ARV) market by analyzing the transactional data on donor-funded ARV procurement between 2003 and 2015, and the ARV price determinants.DesignThe data were obtained from the Global Price Reporting Mechanism (GPRM) managed by the AIDS Medicines and Diagnostics Service of the WHO, and it consists of information that covers approximately 80% of the total donor-funded adult ARV transactions procurement.MethodsExWorks prices and procured quantities were standardized according to the guidelines in terms of yearly doses. Descriptive statistics on quantities and prices show the main trends of the ARV market. Ordinary least squares estimation was carried out for the whole sample, then stratified according to the type of supplier (originator and generic) and controlled for time and geographical fixed-effects. Given that analyses were carried out on a public dataset on ARV transactional prices from the GPRM, ethics are respected and consent was not necessary.ResultsOriginator medicines are on average the least expensive in the sub-Saharan Africa region, where at the same time, generic medicines are on average the most expensive. By contrast, originator medicines are the most expensive in Europe and Central Asia, and generic medicines are the least expensive. In fact, the data suggest mixed strategies by ARV suppliers to exploit opportunities for profit maximization and to adapt to the specific conditions of market competition in each region. Our results also suggest that the expiration of patents is not sufficient to boost additional developments in generic competition (at least in the ARV market) and that formal or informal agreements between generic firms may de facto slow down or even reverse long-term trends towards price decreases.ConclusionsOur findings provide an improved understanding of the ARV market that can help countries strengthen policy measures to increase their bargaining power in price negotiations and the use of TRIPS flexibilities, with a special emphasis on negotiations with generic manufacturers.

Saving Mothers, Giving Life: It Takes a System to Save a Mother

“…Recent models suggest that, at a minimum, an additional US$11 per capita per year is necessary to meet the full needs of MNH care in sub-Saharan Africa 68 . The incremental costs of the SMGL initiative of US$1.36 per person per year in Uganda and US$4.85 per person per year in Zambia are far less than these modeled estimates, and much less than that spent on antiretrovirals per person treated per year, which stood at an average of US$136.80 in 2015 69 . (See the article by Johns and colleagues from the SMGL supplement 70 …”

Promoting Undetectable Equals Untransmittable in Sub-Saharan Africa: Implication for Clinical Practice and ART Adherence

“…HIV clinical practice with ART sets to achieve specific ultimate goals, which eventually results in the optimal well-being of the patient (Box 1). To cure, and get rid of the virus To achieve optimal and persistent VL suppression Reestablishment and safeguarding immune function Reducing adverse drug effects and ART-drug/herb-interaction Preventing transmission or seroconversion Increasing life expectancy for PLWHIV and improve quality of life Reducing opportunistic HIV-related morbidity and mortality With the fall in prices of ART allowing for scaling up of treatment in SSA, the burden of HIV in terms of morbidity and mortality has decreased significantly over the past few decades [36,37]. HIV clinical practice and support systems must be tailored to support the 90-90-90 WHO goals by 2020.…”

“…With the fall in prices of ART allowing for scaling up of treatment in SSA, the burden of HIV in terms of morbidity and mortality has decreased significantly over the past few decades [ 36 , 37 ]. HIV clinical practice and support systems must be tailored to support the 90-90-90 WHO goals by 2020.…”

Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies

“…Tenofovir Disoproxil Fumarate (TDF)–a nucleotide reverse transcriptase inhibitor commonly used in fixed-dose combination ART–is due to expire in 2017 [ 45 ]. Typically, both originator and generic drug prices decrease as associated patents near expiration [ 9 ], hence it is likely that the cost of purchasing current combinations of ART will decrease in the near future. Further, trials have shown that by optimizing antiretroviral dosages such that any negative effect on viral suppression is negligible can help to cut the cost of HIV treatment.…”

“…This high cost of HIV treatment is primarily driven by the exclusion of the Kazakhstan government from voluntary licence agreements that pharmaceutical companies negotiate with generic drug manufacturers due to Kazakhstan’s upper-middle-income country status [ 8 ]. Central Asia–along with Europe–experiences the highest cost of donor-funded ART when procured from originator companies, but also the least expensive when procured from generic manufacturers [ 9 ], highlighting the importance for countries in these regions to have access to the generic ART market. Such high treatment costs in the future would likely hinder the attainment of Kazakhstan’s HIV targets—especially after donor withdrawal.…”