Benchmarking prices of antirretroviral medicines in Central and Latin America: the "Cost" of paying for medicines
V. Wirtz1, C.H. Trout2, Y. Santa Ana Tellez3, W. Kaplan2
1National Institute of Public Health of Mexico, Center for Health Systems Research, Cuernavaca, Mexico, 2Boston University School of Public Health, Center for Global Health & Development, Boston, United States, 3National Institute of Public Health of Mexico, Center for Evaluation Research and Surveys, Cuernavaca, Mexico
Background: We analyzed public procurement prices for selected ARVs in the Latin America/Caribbean (LAC) region and developed regional and global pricing “benchmarks “ in order to estimate the “opportunity cost” of paying high ARV prices.
Methods: Using the Global Price Reporting Mechanism (GPRM) data base provided by the World Health Organization (WHO) for 16 LAC countries' ARV procurements, we calculated procurement prices of eight individual ARVs in different dosages and various first-line and second-line ARV combinations. After calibrating our methodology against an already existing method, we used our method to compared ARV combination procurement prices between countries in 2006. We created several “benchmark” price scenarios to estimate the additional number of patients who could have been treated in each country if the ARV combinations studied were purchased at the various “benchmark” prices.
Results: In 2006, the per-patient-per-year (PPPY) price for first line ARV combinations ranged from $100 to $1,000 for most countries (with three exceptions). For second-line ARV combinations, PPPY prices were, with a few exceptions, all higher than $2,000. Most countries could have treated at least 50% more patients they treaded in 2006 if they had spent their existing ARV procurement dollars using one or more ARV price “benchmarks”.
Conclusions: This is the first LAC regional comparative analysis of ARV prices with benchmarking. A substantial number of additional patients could be treated in the region. It is too simplistic to explain the GPRM price differences identified as solely due to the presence or absence of patent protection and it appears that the ability or inability of the country to negotiate lower procurement prices, training, careful planning as well as the presence of corruption may play an important role. Benchmark methods should be promoted to increase procurement efficiency in the region through provision of market intelligence data to procurement officials.
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