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Antiretrovirals Pricing: The Past, The Present, The Future

Antiretrovirals Pricing: The Past, The Present, The Future. Janice Lee. What did we learn from the past?. Price evolution of stavudine /lamivudine /nevirapine. >99% decrease. 76% decrease. Prices of Improved First Line Regimens At Present. Middle Income Countries.

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Antiretrovirals Pricing: The Past, The Present, The Future

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  1. Antiretrovirals Pricing:The Past, The Present, The Future Janice Lee

  2. What did we learn from the past? Price evolution of stavudine /lamivudine /nevirapine >99% decrease 76% decrease

  3. Prices of Improved First Line Regimens At Present Middle Income Countries

  4. First line, Second line, Third line Prices At Present No competition!

  5. Untangling the Web 13th Edition • Yearly MSF publication since 2001 to provide pricing of ARVs in response to lack of transparent and reliable information on pricing of ARVs • Used as lobby advocacy tool, quotes in publication, source of price comparison, patent informations, access issues • One of the most comprehensive pricing information on originator ARVs • We are online: utw.msfaccess.org

  6. ARVs Cost Projections • Next slides show price projections in 2014 by Clinton Health Access Initiative (CHAI) • Brazilian study showed that 55-99% of the direct manufacturing costs of drug is represented by the active pharmaceutical ingredient (API)1 • Prices are based on CHAI estimation of the products in a commoditized generic market based on costing model where API contributes 70% of the price. Cost estimate of pipeline drug is based on triple FDC and not indicative of single products. Do not address access related issues other than long term cost in a competitive market • Pipeline drugs are showed for the interest of price comparison and more data is needed to determine its safety and efficacy 1 Pinheiro E, Vasan A, Kim JY, et al., Examining the production costs of antiretroviral drugs. AIDS 2006, 20: 1745-1752

  7. Elvucitabine is not yet marketed, in Phase II studies - Achillion

  8. Rilpivirine is not yet marketed, in Phase III studies - Tibotec

  9. Elvitegravir and GS 9350 (cobicistat) is not yet marketed in Phase III studies – Gilead RAL and DVR pricing estimates are derived using conservative long term estimates on anticipated generic API cost and reflect pricing in a commoditized generic market

  10. Potential Savings with Dose Optimization *Source: Andrew Hill, **CHAI estimates

  11. First line with TDF US$176ppy Second line with ATV+RTV US$465ppy Third line with DRV+RTV+ETV+RAL US$3204ppy *Price estimates courtesy of CHAI

  12. In an ideal world… • Cost optimized drugs • Generic competition • No intellectual property access barriers • Improve process chemistry of production resulting in greater price reduction

  13. Is there more to cost? • Cost effectiveness studies are often used as a guide to change a current regimen by measuring the change in cost over the change in health benefits • MSF study in Lesotho analysed 943 patients comparing those started on TDF, AZT and d4T based regimen and the cost associated with treatment, monitoring, hospitalisation, consultations • Results on Oral Late Breaker, Session Room 4, 11.00am-12.30pm tomorrow

  14. Thank You Acknowledgement: Alexandra Calmy – University Hospital of Geneva Andrew Hill – Liverpool University David Ripin – Clinton Health Access Initiative Untangling the Web team

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