Marseille 2007
Marseille 2007
Abstract book
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Abstract #374  -  Determinants of prices of ARV drugs in the developing world: a needless or meaningful battle?
Session:
  6.76: Posters A (Poster) on Monday   in  Chaired by
Authors:
  Presenting Author:   Mr Chauveau Julien - INSERM379/ORS-PACA, France
 
  Additional Authors:  Prof Jean Paul Moatti,  
Aim:
For the past five years, access to antiretroviral therapies (ART) in the developing world has been characterized by an increase of both numbers of people beneficing from treatments and amount of global resources devoted to fight HIV/AIDS. However, drugs still account for an important part of total incremental cost of ART programs and an increasing number of patients need to switch to second line treatments. The problematic of HIV/AIDS drug prices remains crucial to achieve the objective of a universal access to ART by 2010.
 
Method / Issue:
Retrospective data on 993 real ARV transactions that occurred between 1999 and 2004 were collected in 7 countries member of the African Intellectual Property Organization (AIPO) involving a similar legislation for implementation of patent rights protection. For each transaction, standardized source prices and quantities were recorded as well as detailed information about purchased drugs and process of negotiation associated to the transaction. Descriptive analyses were done by using a weighted mean Price per Daily Dose (PDD) index. Logarithms of PDD were used as dependent variable in multiple linear regression models with characteristics of products, transactions and contexts being used as explanatory variables.
 
Results / Comments:
After first procurements, all countries have adopted a hybrid supplying strategy that led to purchases of both generic and branded versions of ARV drugs. Since 2002, part of generic drugs has increased continuously up to become the main supply source for countries of our sample (67% of total purchased volumes in 2004) whereas resort to the Accelerating Access Initiative (AAI) has continuously decreased, either on total purchases or only on branded versions of ARV drugs, the latter having been more often negotiated directly between countries and patent owner producers. After adjustment for all factors, -estimates from multivariate analyses show that both negotiation done in the framework of the AAI (-0.45) and generic competition (-0.43) had an individual significant impact on price decrease but that patent registration with the AIPO remains significantly associated with higher prices (+0.63). Descriptive analyses confirm that the sharp price decrease observed in 2001 for ARV drugs has not been homogenous, mean price index for Protease Inhibitors (PI) and Non-Nucleosidic Reverse Transcriptase Inhibitors (NNRTI) remaining respectively 4 and 2 times higher than Nucleosidic Reverse Transcriptase Inhibitors (NRTI)s mean price index in 2004. Furthermore, the overall price stabilization observed since 2001 was the result of a double evolution, the continuously decreasing trend for prices of first line drugs having been compensated for a price increase of second line ARV.
 
Discussion:
Interaction between patent rights, generic competition and negotiation process was a determinant element of price evolution on the oligopolistic market of differentiated goods of ARV drugs in African countries member of the AIPO. On the most recent period, the price increase of molecules used in second line treatments suggests a strategic positioning from patent owner firms in order to establish their future market power. As treatment becomes more expensive, comprehensive programs may be questioned from a public policy point of view as they may start deviating resources from other health priorities.
 
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