7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


WELBD05 - Oral Abstract

Is the pricing of antiretrovirals equitable? Analysis of antiretroviral drug prices in 20 low- and middle-income countries

Presented by Andrew Hill (United Kingdom).

N. Ford1, J. Ananworanich2, K. Ruxrungtham3, B. Simmons4, A. Hill5

1University of Cape Town, Infectious Diseases, Cape Town, South Africa, 2Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 3Chulalongkorn University, HIVNAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 4MetaVirology Ltd, London, United Kingdom, 5Pharmacology and Therapeutics, Liverpool University, Liverpool, United Kingdom

Background: HIV drug prices have been substantially reduced in the lowest income countries, but low prices may not be consistently available in middle-income countries with large HIV epidemics. There is no mechanism in place to ensure equitable pricing of antiretrovirals in middle-income countries. Several key antiretrovirals are still on patent in middle-income countries, with generic production restricted.
Methods: HIV drug prices used in national programmes (2010-2012) were extracted from the WHO Global Price Reporting Mechanism (GPRM) database. Treatment costs (branded and generic) were compared with per capita annual gross national income (GNI), using the World Bank database. Five key ARV drugs were analysed (EFV, NVP, TDF, LPV/r, TDF/FTC) in countries with large HIV epidemics. Countries were classified as 1. Low income (GNI ≤ $1025/person): Ethiopia, Malawi, Uganda, Tanzania, Kenya, Cambodia, 2. Low-middle income (GNI $1026-$4035): Nigeria, Vietnam, India, Philippines, Indonesia, Ukraine), and 3. Upper-middle income (GNI $4036-$12,475): Namibia, South Africa, Botswana, Thailand, China, Malaysia, Brazil, Russia.
Results: Overall, median treatment costs increased through income categories; for example, median (range) annual LPV/r cost was $407 ($383-435) per person for low-income, $585 ($413-1007) for low-middle income, and $878 ($397-3794) for upper-middle income countries. However, prices remained stable in African countries with rising GNI, but outside Africa there were large prices rises in some middle-income countries, not clearly correlated with higher GNI. Antiretroviral drug prices in upper-middle income countries outside of Africa were significantly higher than African countries with similar GNIs (Table). Highest HIV drug prices were in Malaysia, which has a lower GNI than Russia or Brazil.

Antiretroviral (dose)African countriesnon-African countries
EFV (600mg OD)$60 (51-69)$241 (57-784)
NVP (200mg BID)$30 (29-30)$97 (32-162)
TDF (300mg OD)$107 (79-135)$477 (262-715)
LPV/r (400/100 BID)$425 (397-490)$1000 (793-3794)
TDF/FTC (300/200 OD)$122 (102-143)$468 (157-779)
[Antiretroviral costs per person (US$)]

Conclusions: Non-African middle-income countries pay significantly more for antiretrovirals than African countries with similar Gross National Incomes. We need a new system of fair pricing for antiretrovirals across both African and non-African middle income countries.

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