Resources/impact development
Factors influencing global antiretroviral procurement prices.
Wirtz VJ, Forsythe S, Valencia-Mendoza A, Bautista-Arredondo S. BMC Public Health. 2009. 9 Suppl 1:S6.
Antiretroviral medicines are one of the most costly parts of HIV treatment. Many countries are struggling to provide universal access to antiretroviral medicines for all people living with HIV. Although substantial price reductions of antiretroviral medicines have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global antiretroviral prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on antiretroviral procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to antiretroviral treatment programs. An antiretroviral medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 antiretrovirals, global median prices and price variation were calculated. Linear regression models for each antiretroviral were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Three key factors appear to have an influence on a country’s antiretroviral 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. Factors which did not influence procurement below the highest direct manufactured costs 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. One of the principal mechanisms that can help to lower prices for antiretroviral medicines over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.
For full text access click here: 1
Editors’ note: There has been an unprecedented global effort to increase antiretroviral drug price transparency, including through the requirements of the Global Fund, the Clinton Initiative, and others for countries to report their pricing data. The Global Price Reporting Mechanism (GPRM) provides information on the prices that countries actually paid for antiretroviral medications through its publicly accessible database http://www.who.int/hiv/amds/gprm/en/. Analysis of the GPRM data debunks the assumptions that procuring larger volumes will reduce prices (that was true for only 2 of the 12 drugs studied) and that generic competition leads to equivalent innovator prices (only the second line innovator product lopinavir/ritonavir was associated with lower prices than generic products). Since there is tiered pricing or discounts for most antiretroviral drugs bought by low- and low-middle-income countries, with the exception of the entry inhibitor maraviroc, continued expansion of the GPRM to include data from all countries will increase long-term efficiency (best value for money) in antiretroviral drug procurement.
HIV prevention cost-effectiveness: a systematic review.
Galárraga O, Colchero MA, Wamai RG, Bertozzi SM. BMC Public Health. 2009. 9 Suppl 1:S5.
After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the cost-effectiveness literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and cost-effectiveness estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year(DALY) or quality-adjusted life year (QALY). The authors found 21 distinct studies analyzing the cost-effectiveness of HIV-prevention interventions published in the past four years (2005-2008). Seventeen cost-effectiveness studies analyzed biomedical interventions; only a few dealt with behavioural and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). There are several types of interventions for which cost-effectiveness studies are still not available or are insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse cost-effectiveness evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the HIV epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning.
For full text access click here: 1




November 27th, 2008 at 8:15 pm