Upload
arnaud
View
56
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Access to ARVs in low and middle income countries -. Joseph Perriëns Coordinator HIV technology and commodities HIV dept. World Health Organization. ARV price transparency. Median price (US$ ppy ) paid for second line treatment regimens by LMICs, 2008-2013. - PowerPoint PPT Presentation
Citation preview
Access to ARVs in low and middle income
countries-
Joseph PerriënsCoordinator HIV technology and
commodities HIV dept.
World Health Organization
ARV price transparency
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 -
20
40
60
80
100
120
140
160
180
147 160
145
128 131 128
108 117 113 115
US$
ppy
2008 2009 2010 2011 2012 20130
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
325 336
[ZDV+3TC]+[ATV]+[r] [300+150]mg+[300]mg+[100]mg [ZDV+3TC]+[ATV/r] [300+150]mg+[300+100]mg [ZDV+3TC]+[LPV/r] [300+150]mg+[200+50]mg
Med
ian
price
(US$
/ppy
)
2009 2010 2011 2012 2013DRV (600 mg) NA 3833 3287 5215 5180DRV (300 mg) 5805 1123 1013 732 664ETV (100 mg) 1173 1178 854 854 439RAL (400 mg) NA 980 973 883 553
Median price (US$ ppy) paid for third-line drugs by LMICs, 2008-2013
Average price (US$ ppy) paid for first line treatment by LMICs, 2004-2013
Median price (US$ ppy) paid for second line treatment regimens by LMICs, 2008-2013
Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/
Using price data…Median price and range (US$ ppy) of first line treatment regimens in LMIC, 2013
Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/
Stock-outs require action in financing, supply planning and distribution
2008 2009 2010 2011 2012 20130
5
10
15
20
25
30
35
40
45
50
37 37 38
45
3035
Year
%
% of countries reporting stock out, 2008-2013
Regulatory approvals: a neglected area
% of 139 countries with at least 1 registered supplier of:
[ABC+3TC+NVP] 60+ 50+6 mg
[ABC+3TC] 60+30 mg
[AZT+3TC+NVP] 60+ 50+6 mg
[d4T+3TC+NVP] 30+ 50+6 mg
ABC 60 mg
[d4T+3TC] 60+ 12 mg
[d4T+3TC] 30+6 mg
[d4T+3TC+NVP] 60+ 100+12 mg
[AZT+3TC] 60+30 mg
AZT 10 mg/ml
ABC 20 mg
NVP 10 mg/ml
LPV/r 100+25 mg
3TC 10 mg/ml
LPV/r 80+20 mg/ml
0 10 20 30 40 50 60 70
4
5
10
10
11
11
12
12
15
28
39
48
50
56
58
%
Red bars denote liquid, and blue bars solid for-mulations.
ATV/r
ATV
TDF+FTC
LPV/r
TDF
TDF+3TC
AZT+3TC
TDF+FTC+EFV
TDF+3TC+EFV
EFV 600 mg
NVP
DRV
ETV
AZT+3TC+NVP
0 10 20 30 40 50 60 70 80
1
2
9
13
18
29
31
37
55
55
61
62
68
68
%
Adult formulations Paediatric formulations
In 2012, WHO launched a collaborative procedure with national regulatory authorities to fast-track registration of prequalified medicines. 19 countries now participate.
Progress in intellectual property
• Geographic scope of voluntary licenses increased, and new drugs were licensed, e.g.:• TDF: to 112 countries (Gilead via MPP)• ATV: to 110 countries (BMS via MPP)• Dolutegravir: to 144 countries (ViiV via MPP)• RPV: to 112 countries (J&J, bilaterally)
• Countries with no access to voluntary licenses negotiated lower prices, and have at times resorted to compulsory licenses
• Newer drugs like DRV, RAL, EVG, RPV and TAF remain concerns
Concentration: a threat for competition and supply security
2,006 2,009 2,0120
100000000
200000000
300000000
400000000
500000000
600000000
700000000
800000000
900000000
1000000000
ARV sales to LMIC registered in GPRM (in Million US$)
All others *Macleods Pharmaceuticals Ltd.Abbott/AbbVieRanbaxy Laboratories Ltd.Strides Arcolab Ltd.Cipla Ltd.Aurobindo Pharma Ltd.Hetero Drugs Ltd.Mylan (Matrix Laboratories Ltd.)
Mill
ions
Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/
Acknowledgements
Organizations (contributed data)CHAI, CPS/WHO, GFATM, IDA, JSI, MissionPharma, UNICEF, SCMS, SIAPS/MSH, UNAIDS ,UNITAID, USAID.
Companies(contributed data)Abbvie, Anhui Biochem United Pharm. Co., APIChem Chemical Technology Co. Arch Pharmalabs, Aurobindo Pharma, Aspen Pharmacare, Boehringer Ingelheim, Bristol-Myers-Squibb, CIPLA, Emcure Pharmaceuticals, Gilead Sciences, Glaxo-Smith-Kline, Hoffmann La Roche, Hetero, J&J, Lonzeal Pharmaceuticals, McLeod, Merck Sharp & Dohme, Microlabs, Mylan, Ranbaxy, Shandong Xinhua Pharm. Co., Shanghai Desano Chem. Pharm. Co, Strides Arcolab, Varichem, ViiV.
People(helped write)Vincent Habiyambere (WHO), Boniface Dongmo-Nguimfack (WHO), Peter Beyer (WHO), Francis Aboageye-Nyame (SIAPS/MSH), Martin Autun (GFATM), Nathan Ford (WHO), Robert Matiru (UNITAID), David Jamieson (SCMS), Laurence Läser (WHO), Martina Penazzato (WHO), Chris Wright (JSI), Dominque Zwinkels (SCMS), G Hirnschall (WHO), Andrew Ball (WHO), Michel Beusenberg (WHO), Esteban Burone (MPP), Cees De Joncheere (WHO), Meg Doherty (WHO), Jane Galbao (UNITAID), Zafar Mirza (WHO), Taufiqur Rahman (UNITAID), Jaqueline Sawyer (WHO), Marco Vitoria (WHO), Gundo Weiler (WHO), colleagues in WIPO and WTO.