Transcript Current experience with differential pricing of HIV/AIDS related

Current experience with
differential pricing of HIV/AIDS
related drugs in Uganda
Dorothy Ochola M.D.-Muyingo Sowedi - Malamba S.
Paul J. Weidle, Pharm.D.,MPH, - Joseph Saba, MD.
10 April 2001 – Høsbjør, Norway
Based on experience from UNAIDS Drug Access Initiative
Background (1)
• Estimated population of 21 million
people (1998)
• Average HIV prevalence is 7%.
• An estimated cumulative number of
2,276,000 to have been infected since
the onset of the epidemic in 1982
• 1,438,000 estimated to have died.
• GNP per capita: $310 (1998).
Background (2)
• HIV-related drugs in several categories
– STI drugs provided to patients through STIP
– Basic drugs for treatment of opportunistic
infections
– TB drugs
– Basic drugs for pain relief & symptom control
– Antiretrovirals & sophisticated drugs for
opportunistic infections – patient meets full cost
The UNAIDS/MOH D.A.I.
UNAIDS/MOH HIV Drug Access Initiative.
• Goal: to increase access to HIV-related drugs
and care.
Two major mechanisms:
• Adequate healthcare infrastructures
• Differential pricing and responsive distribution
system
D.A.I.: Implementation
Pilot Program initiated in June 1998.
– Access to antiretroviral drugs initiated 1 Aug.1998.
– National Advisory Board to oversee activities.
– Mechanism for negotiations, procurement and
distribution for ARVs established
– Treatment centres for access to ARVs accredited.
– Training of health providers in correct use of drugs
conducted
– Patients pay for ARV medications and medical visits
ARV Price Analysis - Objectives
Carried out in December 2000 with the
following objectives:
– Describe the cost of ARV drug combinations to
patients in Uganda.
– Describe reasons for price fluctuations of ARV to
patients in Uganda.
– Quantify the price reductions as at end of 2000.
Method
• Information on cost of ARV gathered from
medical Access (U) Ltd.
– From August 1998 – December 2000.
– Costs of drugs purchased in foreign currency
7 converted to Ugandan shillings
• Information on costs of drugs to patients
gathered from treatment centres.
– = cost of drug to medical access plus small
mark-up
ARV price reduction in Uganda
at initiation of DAI – August 1998
$400
Retrovir
Videx
Zerit
Epivir
Crixivan
$350
$300
$270
$230
$221
$284
5 - 49% reduction
$200
Initiation
of DAI
$0
$86
Prior to
DAI
$100
$144
$131
$113
$82
Cumulative enrollment - DAI
N
All
1000
900
800
700
600
500
400
300
200
100
0
Nsambya
Mildmay
Mulago
JCRC
872
912
740
607
512
359
428
273
137
AugSep
98
OctDec
98
JanMar
99
AprJun
99
JulSep
99
OctDec
99
JanMar
00
Apr- Jul-00
Jun
00
Mengo
ARV costs in response to Currency
Valuation & Price Changes
Uganda, 1999-2000
800000
600000
400000
200000
Combivir/Indinavir
Combivir/Nelfinavir
Jul-00
Jan-00
Jul-99
0
Jan-99
Uganda Shillings
1000000
Reasons for recent
price reductions
• Negotiated reductions in the prices of
some drugs from multinational
phamaceutical manufacturers
• Pressure from Governments, PWAs and
other activists in developed countries on
multinational companies
May 2000 announcement:
Further Price Reductions
• 5 pharmaceutical companies/5 UN Agencies
pledged to substancially reduce prices for
developing countries.
• Effected in Uganda – November-December
2000.
• Price reductions for individual products 0-83%
compared to Feb 2000 prices.
• Price reduction not same for all drugs (>50%
for 6 drugs, 25-50% for 2 and <5% for 6
drugs).
COM/RIT/SAQ
DDI/D4T/RIT/SAQ
ZDV/DDI/RIT/SAQ
COM/NFV
DDI/D4T/NFV
ZDV/DDI/NFV
COM/IDV
DDI/D4T/IDV
ZDV/DDI/IDV
COM/EFV
DDI/D4T/EFV
ZDV/DDI/EFV
Feb-00
COM/NEV
COM
$750
DDI/D4T
ZDV/DDI
Cost of 30 days supply of
Combinations of ARVs in Uganda
Feb  Dec 2000
Dec-00
$500
$250
$0
Cost of 30 days supply of
Combinations of ARVs in Uganda
using Generic Vs. Brand Name Drugs - Dec 2000
1,200,000
Brand name drugs only
Generic drugs where possible
800,000
600,000
400,000
200,000
com/RIT/SAQ
DDI/d4t/RIT/SAQ
zdv/DDI/RIT/SAQ
com/NFV
DDI/d4t/NFV
zdv/DDI/NFV
com/IDV
DDI/d4t/IDV
zdv/DDI/IDV
com/EFV
DDI/d4t/EFV
zdv/DDI/EFV
com/nev
com
DDI/d4t
0
zdv/DDI
Uganda Shillings
1,000,000
ENROLMENT AFTER NEW PRICE REDUCTIONS
CENTER
START
DATE
JUL-2000
DEC-2000
JAN 01
*JCRC
01-Aug-98
423 (46%)
452
512
Nsambya
06-Aug-98
286 (31%)
305
345
Mildmay
05-Oct-98
158 (17%)
167
189
Mulago
21-Jun-99
33 ( 4%)
41
41
Mengo
02-Jan-00
12 ( 1%)
12
12
977
1099
Total
912
* Additional 536 patients started purchasing ARVs before August 1998 or had no clinical records at the center
Lessons learned (1)
• The cost of ARVs is only one aspect of total cost
of providing HIV/AIDS care.
• Few HIV/AIDS individuals have adequate
financial resources to purchase ARVs – majority
cannot afford even at current reduced costs.
Lessons learned (2)
• Need more public funding to enhance
healthcare infrastructure and subsidize further
drug costs.
• Depreciation of local currency may affect
patients purchasing power, and therefore quality
of care.
• Further price reductions will enable more of
those previously on dual therapy to access
HAART.
Conclusions
• Differential pricing can be looked at from two
perspectives: the health care provider and the
care seeker.
• In developing countries most care seekers
cannot meet the costs. The provider to some
extent is under obligation to fill the gap.
• We have recently seen important efforts for
differential pricing. What are care providers
prepared to do?