Access to HIV/AIDS treatment in a context of increasing patent protection: an analysis of ARV drug price evolution in Brazil
Presented by Constance Meiners (France).
C. Meiners1,2,3,4, L. Sagaon-Teyssier1,2,5, F. Orsi6, R. Lopes3, M.-P. Carrieri1,2,5, B. Spire1,2,5, L. Hasenclever3, J.-P. Moatti1,2,5
1INSERM, U912 (SE4S), Marseille, France, 2Université Aix Marseille, IRD, UMR-S912, Marseille, France, 3Federal University of Rio de Janeiro, Institute of Economics, Rio de Janeiro, Brazil, 4Ministry of Planning, Budget and Administration, Brasilia, Brazil, 5ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France, 6IRD, SE4S UMR-912, Marseille, France
Background: Brazil delivers antiretroviral treatment (ART) free of charge to nearly 200,000 patients. Assertive price negotiations and local ARV production have been key elements to foster its policy. Lately, drug resistance and toxicity management concerns have led to the progressive adoption of patented drugs. This longitudinal analysis of the Brazilian ARV market aims at identifying the role played by patent protection on drug pricing and the challenges it represents to the sustainability of HIV/AIDS programs.
Methods: Retrospective data on ARV transactions purchased by the Brazilian Ministry of Health between 1998 and 2008 were collected. For every transaction, unit price, quantity, supplier and drug characteristics were recorded. Prices were converted into constant 2008 U.S. dollars. Descriptive analyses were based on price and quantity per daily dosis (PDD, QDD). A multilinear regression on the logarithm of PDD was run using transaction year, the logarithm of QDD, therapeutic class, drug age and patent status as explanatory variables.
Results: Mean PDD reached its lowest value in 2004 (US$ 1.97), having settled at about US$ 3.5 in later years. For the overall period, generic drug mean PDD fell about 71%, while patented drugs 37%. Patented drugs represent one third of purchased quantity and two thirds of ARV budget. Among first-line drugs, branded Tenofovir mean price exceeds generic Zidovudine fourfold. Efavirenz mean price reduced 72% after compulsory license declaration in 2007. Econometric analysis demonstrates price sensitivity to therapeutic class, quantity and drug age (N=555). It highlights the role of patent protection, influencing prices by about 37% (p< 0.001).
Conclusions: The adoption and more extensive use of patented ARVs in Brazil led to an inflection point in the trend of falling ARV prices. As the World Health Organization revises its guidelines, where patent protection is concerned, increasing costs may impair the delivery of higher quality ART in developing countries.
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