Prices Paid for Adult and Paediatric Antiretroviral Treatment by Low- and Middle-Income Countries in 2012: High, Low or Just Right?

Abstract

A viable market for antiretroviral drugs in low- and middle-income countries is key to the continued scale-up of antiretroviral treatment. We describe the price paid by low- and middle-income countries for 10 first- and 7 second-line adult and paediatric treatment regimens from 2003 to 2012, and compare the price of their finished formulations with the price of their active pharmaceutical ingredients in 2005, 2007, 2010 and 2012. Between 2003 and 2012 the median price of adult first-line treatment regimens per treatment-year decreased from USD499 to USD122, and that of second-line regimens from USD2,934 to USD497. In 2005 adult formulations were sold for a price 170% higher than the cost of their active pharmaceutical ingredients. This margin had decreased to 28% in 2012. Between 2004 and 2013, the price of paediatric treatment per treatment-year decreased from USD585 to USD147 for first-line and from USD763 to USD288 for second-line treatment. In 2005, paediatric treatment regimens were sold at a price 231% higher than the cost of their active pharmaceutical ingredients. This margin remained high and was 195% in 2012. The prices paid for antiretroviral drugs by low- and middle-income countries decreased between 2003 and 2012. Although the margins on their sale decreased, there is likely still space for price reduction, especially for the more recent World Health Organization recommended adult first-line regimens and for paediatric treatment.

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“…Drug prices have declined significantly from 2000 to 2014, largely because of price reductions in, and expanded access to, generic ARVs [ 35 , 36 ]. Fixed-dose combinations have lowered the cost of ART in recent years and have improved outcomes through improvements in treatment adherence (patients following recommended treatment dosing and frequency) and persistence (length of treatment) [ 37 ].…”

“…South Africa has been able to negotiate significant price reductions in recent years. However, market analyses suggest that current prices in LICs, particularly for adult first-line treatment, are near the price floor [ 35 , 36 , 38 ]. UMICs and HICs face the biggest challenge in accessing lower prices [ 36 ].…”

“…UMICs and HICs face the biggest challenge in accessing lower prices [ 36 ]. In order to account for uncertainty in future price declines, we used GPRM price trends from 2011 to 2013 and recent ARV market analyses to set ranges for potential annual price declines by country income level [ 35 , 36 , 38 ]. These ranges were included in the Monte Carlo simulation analysis (see Table 2 ).…”

“…In general, we assumed that recent trends in price declines represent the upper bound for future price declines for adult first-line treatment across income groups. For pediatric first- and second-line treatment in middle- and high-income countries, we assumed recent rates of price declines could continue [ 35 ].…”