1 / 19

Luis Sagaon Teyssier ; Yves Arrighi; Boniface Dongmo Nguimfack; Jean-Paul Moatti

Affordability of HIV/AIDS treatment in developing countries: an analysis of ARV drug price determinants. Luis Sagaon Teyssier ; Yves Arrighi; Boniface Dongmo Nguimfack; Jean-Paul Moatti. Aknowledgements. This study is part of a joint project funded by UNITAID and developed by:

ramona-smith
Download Presentation

Luis Sagaon Teyssier ; Yves Arrighi; Boniface Dongmo Nguimfack; Jean-Paul Moatti

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Affordability of HIV/AIDS treatment in developing countries: an analysis of ARV drug price determinants Luis SagaonTeyssier; Yves Arrighi; Boniface Dongmo Nguimfack; Jean-Paul Moatti

  2. Aknowledgements This study is part of a joint project funded by UNITAID and developed by: The French National Agency for Research on AIDS and viral Hepatitis (ANRS-SESSTIM) AIDS Medicines and Diagnostics Service (AMDS/WHO) Foundation for Innovative New Diagnostics (FIND)

  3. Outline • Context • Issues & Objectives • Data • Method • Results • Main conclusions

  4. HIV/AIDS in developing countries 2010 Adults and children living with HIV Adults and children newly infected with HIV Adult prevalence (15‒49) [%] Sub-Saharan Africa 22.9 million [21.6 million – 24.1 million] 1.9 million [1.7 million – 2.1 million] 5.0% [4.7% – 5.2%] Middle East and North Africa 470 000 [350 000 – 570 000] 59 000 [40 000 – 73 000] 0.2% [0.2% – 0.3%] South and South-East Asia 4.0 million [3.6 million – 4.5 million] 270 000 [230 000 – 340 000] 0.3% [0.3% – 0.3%] East Asia 790 000 [580 000 – 1.1 million] 88 000 [48 000 – 160 000] 0.1% [0.1% – 0.1%] Latin America 1.5 million [1.2 million – 1.7 million] 100 000 [73 000 – 140 000] 0.4% [0.3% – 0.5%] Caribbean 200 000 [170 000 – 220 000] 12 000 [9400 – 17 000] 0.9% [0.8% – 1.0%] Eastern Europe and Central Asia 1.5 million [1.3 million – 1.7 million] 160 000 [110 000 – 200 000] 0.9% [0.8% – 1.1%] Western and Central Europe 840 000 [770 000 – 930 000] 30 000 [22 000 – 39 000] 0.2% [0.2% – 0.2%] North America 1.3 million [1.0 million – 1.9 million] 58 000 [24 000 – 130 000] 0.6% [0.5% – 0.9%] Oceania 54 000 [48 000 – 62 000] 3300 [2400 – 4200] 0.3% [0.2% – 0.3%] TOTAL 34.0 million [31.6 million – 35.2 million] 2.7 million [2.4 million – 2.9 million] 0.8% [0.8% - 0.8%] Source: WHO & UNAIDS

  5. Number of people receiving antiretroviral therapy in low- and middle-income countries, by region, 2002–2010 Source: WHO. UNAIDS, UNICEF

  6. ARV market structure • Demand-side • Donor funded ARV transactions • Supply-side • Branded segment • 8 manufacturers • 18 single and 6 co-formulations • Production: 31.8% in USA; 19.5 UK; 11.6% FR; 11.3 NL • Generic segment • 26 manufacturers • 17 single, 11 co-formulations, and 4 co-blisters • Production: 91% in India; 6.5% South Africa

  7. Issues & Objectives • ↑ Resistance + Toxicity • Adoption of patented drugs especially for 2nd and 3rd lines • Switching to new guidelines (d4T to TDF, ZDV) • Financial crisis • Objectives • To identify the main price determinants • To study the evolution of prices of branded drugs through the life-cycle of patents

  8. Data • Global Price Reporting Mechanism (AMDS/WHO) • Period of analysis: 2003-2012 • 44,354 transactions of Adult & Children ARVs • 128 countries • 20 ARVs ; 15 FDC/Co-blisters (88 formulations) • 12 Sources providing information on transactions: • Global Fund (38.2%); SCMS (20.9%); UNICEF (14.5%); UNITAID (12.7%); IDA (9.3%); PEPFAR (5.4%); Mission Pharma (2.1%); CHAI (1%); JSI (0.4%); WHO/CPS (0.4%); MSH (0.3%); WHO (0.3%)

  9. Methods: Price descriptives & OLS • Econometric analysis of price determinants: • Dependent:price of patient-year treatment log(PYD) • Explanatory: • Year dummies • Geographical group (World Bank definition) • Gross National Income per capita (World Bank): log(GNIpc) • Purchased quantity of yearly doses per transaction: log(QYD) • Formulation type (single=ref., co-blister, FDC) • Target group (pediatric=1, adult=0) • Drug age since FDA approval • Number of observed suppliers • Present in 1st line (yes=1, no=0) • Segment(branded=1, generic=0) • Crossed effects:Segment & Present in 1st line • Crossed effects: Segment & years until expiration of the initial patent at the time of purchase of branded drugs (linear and squared effects)

  10. Brand/Generic Market share in value* The numbers in the figure indicate millions of US$ Source: GPRM (AMDS/WHO): * 2011-2012 the bulk data has not still been provided by the sources

  11. Treatment price per patient per year* From 2002 to 2012, 5% of the total yearly treatments was purchased in the branded segment: this represents 15% of the total expenditure in ARVs. Source: GPRM (AMDS/WHO): * 2011-2012 the bulk data has not still been provided by the sources

  12. Treatment price per patient per year by therapeutic line* 3rd line: DRV and ETV, mean price from 1,362 US$ (2010) to 1,758 US$ (2011) Source: GPRM (AMDS/WHO): * 2011-2012 the bulk data has not still been provided by the sources

  13. Mean price per patient per year:adults by therapeutic class Mean price per patient per year:adults by therapeutic class **FDC: FTC+TDF; 3TC+d4T; 3TC+TDF; 3TC+ZDV **FDC & *FDC: FTC+TDF; 3TC+d4T; 3TC+TDF; 3TC+ZDV **FDC & Co-blister: ABC+3TC+ZDV; ABC/[3TC+ZDV] ***FDC & Co-blister: EFV+FTC+TDF; EFV+3TC+TDF; EFV/[3TC+d4T]; 3TC+NVP+d4T; 3TC+NVP+ZDV; NVP/[3TC+ZDV]; EFV/[3TC+ZDV]Co-blister: ABC+3TC+ZDV; ABC/[3TC+ZDV] ***FDC & Co-blister: EFV+FTC+TDF; EFV+3TC+TDF; EFV/[3TC+d4T]; 3TC+NVP+d4T; 3TC+NVP+ZDV; NVP/[3TC+ZDV]; EFV/[3TC+ZDV]

  14. Results (1/4) Time trend Significant at: ***1%; **5%; *10%

  15. Results (2/4) Geographical group Prices in South Asia & East Asia and Pacific are 27% lower than prices in Europe and Central Asia GNI per capita. log(GNIpc): 0.024*** 10% of increase in GNIpc causes an increase of prices of 0.24%: In average, upper-middle income countries pay the highest prices. Significant at: ***1%; **5%; *10%

  16. Results (3/4) Drug and market characteristics Significant at: ***1%; **5%; *10% • Co-blister formulation is 130% more expensive than single formulation • 1 additional supplier in the market reduces prices in average of about 3.3% • Drugs present in 1st line are 65.3% cheaper than drugs in 2nd line • Branded drugs are 56.3% more expensive than generic drugs

  17. Results (4/4) Segment & Present in 1st line: 0.113*** Branded in 1st line are 11.3% more expensive than generic in 1st line. Segment & years until expiration of the initial patent at purchase of branded drugs (linear and squared effects): 0.026*** & 0.002*** 16% more expensive than… 22.4%more expensivethan… Ref: Purchase the same year of patent expiration 9.5%cheaper than…: Years before patent expiration Years after patent expiration

  18. Main conclusions • Genericcompetition has been the driving force for ARV pricedecreasesalthoughwemaybe close to marginal cost for first line drugs • ARV priceremain a major barrier for switching to 2nd and 3rd lines • Brand firmstrategies (during the patent periodand at patent expiration) remain a majour source of higherprices

  19. The debate on Intellectual Property Rights and TRIPS agreements is not over! Contacts: Jean-paul.moatti@inserm.fr luis.sagaon-teyssier@inserm.fr

More Related