ARV prices in the Netherlands Antilles; challenges to get access to affordable treatment
Medecins du Monde - NL, Amsterdam, Netherlands
Background: High prices for ARV drugs in the Netherlands Antilles constitute a financial burden for the health care system, and present a barrier to people in need of accessing antiretroviral treatment. This study aims to elucidate prices, price composition and affordability of ARV drugs. Furthermore, it describes factors contributing to high ARV prices, and strategies that may result in effective price reductions.
Methods: ARV procurement prices were gathered from three different pharmacies at St Maarten and Curacao. Information on price composition was found through local health authorities. Prices per unit were compared to international/regional reference prices using WHO/HAI methodology. Affordability was determined by comparing it to the number of days wages paid for treatment by the lowest paid unskilled government worker. Through semi-structured interviews, factors contributing to high ARV prices and suggestions for effective ways to tackle the ARV price issue were explored. These suggestions were verified by consulting experts, and by literature research.
Results: Prices are significantly higher than international and regional reference prices, and comparable to those in Aruba and in the Netherlands. Treatment is unaffordable according to WHO/HAI criteria. Factors contributing to high ARV prices include a small-scale market, relatively high GNI per capita, high mark-ups, and limited political will. The constitutional status of the Netherlands Antilles is an important additional contributing factor. Options to effectively reduce ARV prices include pooled procurement, price negotiations, limiting maximum mark-ups, challenging patent laws, regional collaboration and increased political commitment, both at the local and Kingdom level.
Conclusions: There are various options to tackle the ARV price issue, and improve access to HIV treatment. Political leadership is crucial to establish effective measures.
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