whether the country is a member of the Clinton HIV/AIDS Initiative

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.

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.