2nd line and recent ARVs prices and

access issues

Carmen Pérez CasasAccess Campaign

MSF May 2006

Measuring prices of ARVS in pilot surveys

-Very few ARV drugs available in surveys using WHO/HAI manual - some core list ARVs are rarely used now- sampling method inappropriate-In some countries ARVs are free or subsidized,- international reference prices not always not always available

Fluconazole price differences: example from pilot surveys

procurement prices in 2001 (US$/200mg cap)

0,17

1,45

9,44

0

2

4

6

8

10

Kenya Median

Originator

South Af rica Median

Originator

MSH median

Only data for some OIs available from pilot surveys

Mea

- There is some information on prices for procurement purposes (UNICEF/WHO/UNAIDS/MSF Sources & Prices, MSF Untangling the Web)

- Website data bases (WHO GPRM, Gfund ) - Some studies- Need more information about the end user

prices- HAI/WHO hope to develop a separate method

for measuring total treatment cost of AIDS (and other chronic diseases).

What kind of information on prices of ARVS is available?

Prices and acces issues in 2nd line ARVS : Lessons from the past (older ARVs)• Generic competition (most existing

patents before 1995) :– lower prices, to US$132– And FDCs (3-in-1 pill) to improve

adherence• Quality sources -- many WHO

prequalified generics• Affordability and availability

allowing more rapid scale-up

Older ARVs: competition lowering prices (Lowest offered prices US$ for yearly triple- d4T + 3TC + NVP)

June 2006, $132 Cipla

Are these “low”prices still a barrier in access to ARVs?

• Example: MSF Survey in Nigeria to measure how affordable are the current user fees for a Nigerian patient in need of ART

• Income : nearly 50 % of the interviewed MSF patients (n= 89) live on < 36US$ monthly

• Monthly ART cost before enrollment in the free MSF-program: 40 US$ for ARVs

Answers to sources of financing ART (n=89)

39%

18%25%

12%

6%Borrow/begging

Sell property

Support fromfriends and family

Using personalsavings

Others

61%

14%

17%

1%

FINANCE

out ofgovt.stock

SIDEEFFECTS

SOCIAL

HEALTH OK

FAILURE TOIMPROVE

OTHER

72% of all ARV experienced interviewed people (n= 122) had ART interruption : causes?

1%

6%

Source: DST/AIDS

11

Current Prices of 2nd-Line ARVs

Price of 2nd-Line treatment as average of the 12 combinations recommended in the new draft WHO guidelines

Source: CHAI (average annual cost in US$ reported by GPRM)

$6,000

$1,40010x

$140

40x

1st Line(Africa)

2nd Line(Africa)

2nd Line

(Middle

Income)

Abbott price for LPV/r ( yearly,US$, in 2005)

500

6 701

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

8 000

Abbott

for

Africa

Brazil Ecuador

MSF

GF lowest

reported

China

MSF

Guatemala

MSF

GF

highest

reported

UK

How to decrease recent ARVs prices?

Enabling Factors for Starting & Scaling Up ARV Treatment were:

• Reductions in prices of 1st line treatments through generic competition

• Simplification of treatment (esp. development and use of FDCs)

• WHO prequalification

Situation post-2005... unless IP flexibilities used

ADULT JUNIOR BABY

Fixed-Dose Combination of d4T/3TC/NVP

FDCfor adult and

children

No adapted formulations ..... or some adapted R&D but not accesible

• « Now you can take KALETRA in .. 4 tablets, with or without food, and with no refrigeration requirements »

.

• Keep at –2 to 8 Cº.• <25ºC during two

months

Post-2005... unless IP flexibilities used

ADULT JUNIOR BABY

Fixed-Dose Combination of d4T/3TC/NVP

New drugs for chronic diseases

…. we will face same challenges in other chronic diseases as new medicines are developed for richer nations chronic patients .

Will they be affordable and adapted for developing nations??

AIDS IS ONE CHRONIC DISEASE. ACCESS TO NEWER AND ADAPTED TREATMENTS

WILL BE NECESSARY EVERYWHERE

Since more patients in the future will need them, we need to start thinking about getting affordable and available second

line drugs now.