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									 2nd line and recent ARVs
    prices and access
           issues

Carmen Pérez Casas
 Access 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
     Only data for some OIs available from pilot surveys

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

               9,44
10
8
6
4                              1,45
2
0                                                  0,17
        Kenya Median   South Africa Median   MSH median
          Originator       Originator
 What kind of information on prices of
ARVS is available? 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).
 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)


                                    Borrow/begging
        6%
                              39%
12%                                 Sell property



                                    Support from
                                    friends and family


  25%                               Using personal
                        18%         savings


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

                                                FINANCE


                                                out of
            17%                                 govt.stock
       1%
     1%                                         SIDE
   6%                                           EFFECTS
                                                SOCIAL


                                                HEALTH OK
 14%

                                                FAILURE TO
                                                IMPROVE
                                  61%
                                                OTHER
Source: DST/AIDS
Current Prices of 2nd-Line ARVs



     40x                    $6,000
                                     Price of 2nd-Line
                                        treatment as average
                                        of the 12 combinations
                                        recommended in the
                                        new draft WHO
                                        guidelines
                                     Source: CHAI (average
     10x       $1,400                   annual cost in US$
                                        reported by GPRM)
    $140

    1st Line   2nd Line   2nd Line
    (Africa)   (Africa)   (Middle
                                                        11
                          Income)
  Abbott price for LPV/r
( yearly,US$, in 2005)

 8 000                                                     6 701
 7 000
 6 000
 5 000
 4 000
 3 000
 2 000     500
 1 000
     0
         Abbott   Brazil   Ecuador GF lowest China Guatemala     GF      UK
          for               MSF   reported   MSF     MSF       highest
         Africa                                            reported
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
     FDC
for adult and
  children




 ADULT      JUNIOR      BABY
  Fixed-Dose Combination of
        d4T/3TC/NVP
  No adapted formulations ..... or some
 adapted R&D but not accesible

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




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

								
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