Transcript Forecasting for ARVs medicines

Forecasting for ARVs medicines
Baseline Estimates
November 2005
Methods
Volumes of the currently sales of ARVs were collected from
AMDS partner organizations ,and grouped in 3 groups:
•Low Income countries
•Middle Income countries
•Brazil
Calculation of the number of patients from
procurement data
1) Number of smallest pharmaceutical units procured was converted in
number of patient-years of drugs used
2) Percentage of individual drugs used was expressed against the total
volume of API procured (expressed in patient-years)
3) Drugs were deemed to be used as first line and second line drugs when
recommended as such for the majority of patients according to the 2003
WHO ART guidelines.
WHO recommendations for first and second
line drugs
First line ARVs
NRTI
stavudine (d4T), zidovudine (ZDV), lamivudine (3TC)
NNRTI
nevirapine (NVP), efavirenz (EFV)
Second Line
NRTI /NtRTI
Tenofovir (TDF), abacavir (ABC), didanosine (ddI),
PI
lopinavir (LPV), ritonavir (r), saquinavir (SQV) , indinavir (IDV),
nelfinavir (NFV), atazanavir (ATV).
Volume de ARV transactions reported in GPRM
between January 1,2005 and July 31,2005 (in patient-years)
First line
Low Income
countries
Middle Income
countries
Zidovudine (ZDV)
5%
5%
Stavudine (d4T)
25%
27%
Lamivudine (3TC)
31%
30%
Nevirapine (NVP)
28%
26%
7%
8%
Efavirenz (EFV)
Volume de ARV transactions reported in GPRM
between January 1,2005 and July 31,2005 (in patient-years)
Second Line
Low Income
countries
Middle Income
countries
Abacavir(ABC)
0,2%
0,2%
Tenofovir (TDF)
1,0%
0,0%
Emtricitabine(FTC)
0,4%
0,0%
Didanosine (ddI)
0,3%
0,9%
Indinavir (IDV)
0,5%
0,8%
0,3%
0,1%
Nelfinavir (NFV)
0,2%
0,3%
Saquinavir(SQV)
0,0%
0,1%
Ritonavir (boost)
0,7%
0,6%
Lopinavir + ritonavir (LPV/r)
Volume de ARV transactions reported in GPRM
between January 1, 2005 and July 31,2005(in patient-years)
Low Income
countries
Middle Income
countries
Total volume of API
patients/year
321,770
83,450
Number of patients
years of triple therapy
(approximation)
106,500
27,800
Volume of ARV transacted in Brazil January 1 to December 31,
In 2004 patient-years
BRAZIL
First line
Zidovudine (ZDV)
Stavudine (d4T)
% of total volume of patients/years
22%
8%
Lamivudine (3TC)
28%
Nevirapine (NVP)
4%
Efavirenz (EFV)
12%
Volume of ARV transacted in Brazil January 1 to December 31,
In 2004 patient-years
Second line
BRAZIL
% of total volume of patients/years
Abacavir(ABC)
Tenofovir (TDF)
Emtricitabine (FTC)
Didanosine (ddI)
Indinavir (IDV)
Lopinavir + ritonavir (LPV/r)
Nelfinavir (NFV)
Saquinavir(SQV)
Atazanavir (ATV)
Amprenavir (APV)
Ritonavir - Boost (r)
0,5%
0,8%
0,0%
5,0%
2,0%
4,0%
4,0%
0,5%
1,0%
0,2%
8,0%
Volume of ARV transacted in Brazil
January 1,2004 to December 31, 2004 (in patient-years)
Brazil
Total volume of API patients/year
487,307
Number of patients years of triple
therapy (approximation)
156,300
A glimpse of the future:
Likely orientation of the 2006 WHO ART guidelines
Comparison of 1st and 2nd Line ARV Drug Formularies for Adults
and Adolescents (2003 vs 2006)
WHO ART Guidelines
2003 ARV Guidelines: ARV Drug
Formularies
1st Line Drug Formulary
d4T
NVP
2nd Line Drug Formulary
ABC
SQV/r
3TC
ZDV
EFV
ddI
TDF
2006 Revision ARV Guidelines
(Preliminary Proposal): Add TDF and
ABC as part of 1st line NRTI backbone
or as a 3rd drug in the regimen (triple
nuke approach).
ZDV or d4T
NVP
3TC or FTC
TDF or ABC
ddI or TDF
LPV/r
ABC
ATV/r or LPV/r or SQV/r
EFV
ZDV (± 3TC)
EFV or NVP
A glimpse of the future:
Likely orientation of the 2006 WHO ART guidelines
Comparison of 1st and 2nd Line ARV Drug Formularies for Adults
and Adolescents (2003 vs 2006)
d4T*or ZDV
Triple NRTI alternative
EFV
3TC or FTC
NVP
ABC or TDF
Classical NRTI/NNRTI approach