Abstract #355  -  Analysis of antiretroviral drug prices in Latin America: identifying opportunities to increase procurement efficiency
Authors:   Presenting Author:   MSc. Yared Santa Ana Tellez - National Institute of Public Health Mexico
Additional Authors:  PhD Veronika  Wirtz, PhD Warren Kaplan, MPH Clinton Trout,
Aim: To analyze procurement ARV prices of Latin American countries and to evaluate impact of price changes for first- and second-line treatment.
Method / Issue: The procurement prices for a selection of eight commonly used first-line and second-line adult ARV combinations were obtained for all Latin American countries for 2006 included in the Global Price Reporting Mechanism (GPRM) database from the World Health Organization (WHO). For four countries not included in the GPRM (Chile, Brazil, Argentina and Mexico) countries procurement offices were contacted directly to request procurement price information. Prices were expressed in US dollars per patient per year and plotted against the gross national income (GNI) of each country. Two hypothetical scenarios using the production cost as benchmark were modeled: one scenario in which countries would procure ARVs at the lowest direct manufacturing cost (LDMC) and the other in which countries would procure ARVs at the highest direct manufacturing cost (HDMC). The proportion of additional patients in the region which could receive ARV treatment per year for first and second-line treatment were calculated.
Results / Comments: Prices varied greatly between countries: the variation for first-line ARV treatment was between $142 for Honduras and $4,789 for Mexico. For second line treatment prices varied between $698 in Haiti and $8,916 in Mexico. The prices of first-line treatment were exponentially related to GNI explaining 78% of the variation, although there were countries of similar GNI with significant price differences. Second-line treatment did not follow this trend. If procurement prices for first-line treatment would not exceed the LDMC 34% more patients could be treated in Latin America and 5% more patients if prices would not exceed HDMC. For second-line treatment 72.5% more patients could be treated if countries in the region would pay the LDMC and 30% if paying the HDMC.
Discussion: The use of regional data on procurement prices can provide useful benchmarks and model the effects of changes in procurement policies. The majority of countries in Latin America procured first-line ARV at prices higher than LDMC and second-line ARV higher than the HDMC. This means that there are large opportunities to treat more patients without increasing financial resources.
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