Abstract #392  -  Explaining diffeences in the cost of amtiretrovirals in developing countries: Maximising value for money
Authors:   Presenting Author:   Dr Veronika Wirtz - National Institute of Public Health
Additional Authors:  Dr Steven S.  Forsythe, Dr Atanacio  Valencia-Mendoza, Dr Sergio Bautista-Arredondo, Dr Yared Santa Ana-Téllez,
Aim: Background: Antiretroviral medicines (ARVs) are the single most costly component of an AIDS treatment program. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS (PLWHA). Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the future remains a major challenge. The incidence of HIV is constant or increasing in most countries and PLWHA are living longer, requiring second and third line therapies which are significantly more costly than first-line therapy. Among other elements in the medicines supply chain, prices, procurement procedures and policies are all crucial to increasing the sustainable and universal access to ARVs. Aim of the paper: To assess the long-term consequences of ARV procurement and to identify policies and practices that could assure long-term sustainable access to ARVs. Aim of the paper: To assess the long-term consequences of ARV procurement and to identify policies and practices that could assure long-term sustainable access to ARVs. Objectives: To analyze ARV prices variations between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; To discuss the options of procurement processes and policies which should be considered when implementing or reforming access to ARV programs
Method / Issue: Methods and data sources: An analysis of ARV price variation between 2005 and 2008 was carried out using the Global Price Reporting Mechanism (GPRM) from the World Health Organization (WHO). A selection of 12 ARVs was identified and price reductions were evaluated for both innovator and generic products. Linear regression models for each ARV were used to identify factors which were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest direct manufacturing cost (HDMC) and lowest direct manufacturing costs of production (LDMC).
Results / Comments: Results: There is a large ARV price variation across countries, even for those countries with a similar socioeconomic status. The price reductions between 2005 and 2008 were greatest for those ARV which had more providers. Three key factors appear to have an influence on a country’s ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative (CHAI). Factors which did not influence procurement below the HDMC were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
Discussion: Discussion: Three principal mechanisms which can help to lower prices for ARV over the next decades are: 1) increasing procurement efficiency, 2) encouraging competition among manufacturers and 3) emphasizing the need for improved production efficiency. To achieve higher procurement efficiency the use of global data on prices can provide a useful tool. However, this needs to be complemented with more research on optimizing procurement methods, including third party negotiation such as CHAI. In addition, strategies should be pursued to increase production efficiency and competition among manufacturers through the use of trade-related aspects of intellectual property rights (TRIPS) flexibilities with the support of international organizations
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