Antiretroviral drug prices

Allocating scarce financial resources for HIV treatment: benchmarking prices of antiretroviral medicines in Latin America

Wirtz VJ, Santa-Ana-Tellez Y, Trout CH, Kaplan WA. Health Policy Plan. 2012 Feb 24. [Epub ahead of print]

Public sector price analyses of antiretroviral (ARV) medicines can provide relevant information to detect antiretroviral procurement procedures that do not obtain competitive market prices. Price benchmarks provide a useful tool for programme managers and policy makers to support such planning and policy measures. The aim of the study was to develop regional and global price benchmarks which can be used to analyse public-sector price variability of antiretrovirals in low- and middle-income countries using the procurement prices of Latin America and the Caribbean (LAC) countries in 2008 as an example. Wirtz and colleagues used the Global Price Reporting Mechanism (GPRM) data base, provided by the World Health Organization (WHO), for 13 LAC countries' antiretroviral procurements to analyse the procurement prices of four first-line and three second-line antiretroviral combinations in 2008. First, a cross-sectional analysis was conducted to compare antiretroviral combination prices. Second, four different price 'benchmarks' were created and the authors estimated the additional number of patients who could have been treated in each country if the antiretroviral combinations studied were purchased at the various reference ('benchmark') prices. Large price variations exist for first- and second-line antiretroviral combinations between countries in the LAC region. Most countries in the LAC region could be treating between 1.17 and 3.8 times more patients if procurement prices were closer to the lowest regional generic price. For all second-line combinations, a price closer to the lowest regional innovator prices or to the global median transaction price for lower-middle-income countries would also result in treating up to nearly five times more patients. Some rational allocation of financial resources due, in part, to price benchmarking and careful planning by policy makers and programme managers can assist a country in negotiating lower antiretroviral procurement prices and should form part of a sustainable procurement policy.

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Editor’s note: Greater transparency in the prices of medicines, supported by publicly available drug price databases, can lead to lower negotiated antiretroviral procurement costs with resultant capacity to treat more people living with HIV. The four benchmarks to measure procurement performance used here¾cost of production, lowest regional generic price, lowest regional innovator price, and global median transaction price for low- and middle-income countries¾allow comparative analysis among countries, with each benchmark having pros and cons. The comparator metric used (patient ratio) is straightforward: the number of patients that could have been treated using each benchmark price compared to the number treated according to annual expenditure for each of seven drug combinations. What is striking in this paper are the unexplained differences between countries. Why are El Salvador and Peru procuring first-line combinations at more than the global median procurement price benchmark and what can El Salvador and Guatemala do to bring down the high prices they are paying for second-line regimens? Using data from the WHO Global Price Reporting Mechanism, as was done in this analysis for 13 countries in the Latin America and Caribbean (LAC) region, will no longer be possible for this region because many LAC countries are now not receiving funds from the Global Fund which requires such reporting. Countries in LAC need to determine quickly how best to share price information so that they can undertake the kind of benchmarking described here to evaluate their procurement efficiencies. The opportunity costs of people living with HIV not accessing antiretroviral treatment are too important to ignore.

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