Article

Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases.

Boston University School of Medicine, Boston, MA 02118, United States of America.
Bulletin of the World Health Organisation (Impact Factor: 5.11). 08/2009; 87(7):520-8. DOI: 10.2471/BLT.08.058925
Source: PubMed

ABSTRACT To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment.
We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002-October 2007) from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4-21% less expensive than medium- or low-volume purchases. Nine of 13 generic ARVs were priced 6-36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23-498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents.
Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored.

0 Bookmarks
 · 
119 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the government pays for approximately 20% of drugs used in India, private out-of-pocket expenditure in India on health-care is one of the highest in the world. Preparing pharmacoeconomics guidelines will be an important step in order to establish Health Technology Assessment (HTA) in India. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines and prioritizing interventions that represent the greatest value within a limited budget. All this calls for action, both by government and civil-society organizations, to make access to essential medicines a priority.
    International journal of pharmaceutical investigation. 07/2014; 4(3):109-11.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The deadliest Ebola outbreak the world has ever seen is currently ravaging West Africa, despite the concerted efforts of the World Health Organization and many national governments. The current picture is troubling, but not altogether unexpected. Ebola was initially identified in 1976, and since that time, few drugs have been developed to combat it. The same is true for myriad other dangerous infectious diseases to which the world is currently susceptible. One proposal that might prevent outbreaks of this scale and magnitude from recurring would be to have the World Health Organization (WHO) and its technical partners assess which of its member states are at high risk for a disease, either directly or indirectly, and facilitate the creation of international governmental risk pools of those member states. Risk pools would offer open-indexed grant contracts to fund vaccine and drug development for a particular disease, and pharmaceutical companies could browse the index to apply for these grants. If the risk-pool states and a particular company sign a contract, a mutually agreed upon amount of the vaccine or drug would be produced at a below-market purchase price for those states. In return, the company would keep any patents or intellectual property rights for the developed vaccines or drugs. Risk-pool countries that did not use their vaccine or drug could resell that supply on secondary markets to other countries outside of the risk pool. This arrangement will increase the supply of tested drug and vaccine candidates available for combatting unexpected outbreaks of any previously discovered major infectious disease in the future.
    The Yale journal of biology and medicine 12/2014; 87(4):473-479.
  • [Show abstract] [Hide abstract]
    ABSTRACT: One often‐highlighted contemporary phenomenon in the pharmaceuticals industry is the use of “tiered pricing”, where essential medicines are sold more cheaply in low‐income than high‐income countries to widen access. With economists having for decades championed the applicability of such pricing to pharmaceuticals, this could be interpreted as a textbook case of “economic performativity”—the economic world increasingly conforming to economic models. In reality, however, tiered pharmaceutical pricing remains rare. Yet this article nonetheless urges retention of the performativity concept, albeit suitably reworked. For, insofar as the industry demonstrates nominal commitment to the model and to the social principles associated with it, it performs valuable political work. Moreover, it does help perform the pharmaceutical economy, by reproducing it in its existing form: repeatedly questioning the model's workability, Western manufacturers are able to continue to avoid putting it widely into practice and, in the process, jeopardizing the profits generated by conventional pricing.
    Antipode 09/2014; 46(4). · 1.89 Impact Factor

Full-text (2 Sources)

Download
34 Downloads
Available from
May 31, 2014