Evolution of prices for antiretroviral drugs in Senegal

Evolution of prices for antiretroviral drugs in Senegal

Objective
Evolution of prices for
antiretroviral drugs in Senegal
1998 – 2006
Koïta Fall M. B. (Fann Clinical Research Center),
Diop K. (Ministry of Health, Senegal),
Taverne B. (IRD, UMR 145).
- Describe the evolution of prices for the
different ARV molecules available in Senegal,
- Identify the main circumstances and causes
for the price decrease, and
- Assess the impact of updating therapeutic
recommendations (notably second-line
regimens) on treatment costs.
Universal Access to care, July 2nd, 14:00 – 16:00
AIDS Impact – Marseille, 2007
Methods
- Prices for ARV drugs available in Senegal
were gathered from drug delivery orders
provided by the National Supply Pharmacy
(NSP) since 1998.
- Prices have been compared to those on the
international market, as indicated in the Pricing
Guide for the Purchase of ARVs for
Developing Countries (9th edition, MSF, 2006).
ARVs Available in Senegal (1)
• NRTI:
- Didanosine (tab. 100 mg, 200 mg): 1998, 2000
- Emtricitabine (cap. 200 mg): 2004, clinical trial
- Lamivudine (syrup, tab. 150 mg): 1999, 1998
- Stavudine (cap. 30 mg, 40 mg): 1998
- Zidovudine (syrup, cap. 100 mg, tab. 300 mg): 1999,
1998, 2000
- Zido.+Lami. (tab. 300 mg+150 mg): 2000
• NtRTI :
- Tenofovir (tab. 300 mg): 2006
ARVs Available in Senegal (2)
• NNRTI:
- Efavirenz (cap. 200 mg, then tab. 600 mg): 2000, 2004
- Nevirapine (syrup, tab. 200 mg): 2001
• PI:
- Indinavir (cap. 400 mg): 1998
- Nelfinavir (tab. 250 mg): 2000
- Lopinavir/Ritonavir (cap. 133 mg+33 mg): 2005
Price variation for different therapeutic
families
1
Prix NNRTI & PI 1998 - 2006
Prix des NRTI 1998 - 2006
6 000
2 500
ppy $
ppy $
AZT 300
ddI 200
d4T 40
3TC
AZT 3TC
2 000
1 500
1 000
5 000
EFZ
NVP
IDV
NFV
4 000
3 000
2 000
500
1 000
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
Didanoside 200 mg
1800
ppy $
Sénégal
original
générique
1500
Price variation for Nucleoside
Reverse Transcriptase Inhibitors
1200
900
600
300
0
2000
2001
2002
2003
2004
2005
2006
Lamivudine 150
Zidovudine 300
350
1400
ppy $
Sénégal
original
générique
1200
1000
ppy $
250
800
200
600
150
400
100
200
50
0
2000
2001
2002
2003
2004
2005
2006
Sénégal
original
générique
300
0
2001
2002
2003
2004
2005
2006
2
Efavirenz (200 mg, 600 mg [2004])
1600
ppy $
Sénégal
original
générique
1400
Price Variation of Non-Nucleoside
Reverse Transcriptase Inhibitors and
Protease Inhibitors
1200
1000
800
600
400
200
0
2001
2002
2003
2004
2005
2006
Nelfinavir 250 mg
Nevirapine 200 mg
700
6000
Sénégal
original
générique
600
ppy $
500
ppy $
Sénégal
original
générique
5000
4000
400
3000
300
2000
200
100
1000
0
2001
2002
2003
2004
2005
2006
0
2000
2001
2002
2003
2004
2005
2006
First-Line Costs, Senegal, 2006
Therapeutic Regimen
Price Variation for
Therapeutic Regimens
Cost (ppy $)
AZT, 3TC, NVP
255
AZT, 3TC, EFZ
498
d4T, 3TC, NVP
167
d4T, 3TC, EFZ
409
3
Zidovudine, Lamivudine, Efavirenz
Zidovudine, Lamivudine, Nevirapine
3 000
1 800
ppy $
1 655
1 555
1 500
Sénégal
1 555
ppy $
original
1 200
2 500
Sénégal
original
générique
2 504
2 000
générique
1 625
1 500
900
600
1 725
1 000
458
969
458
300
255
969
498
500
0
2001
2002
2003
2004
2005
0
2006
2001
Stavudine, Lamivudine, Nevirapine
1 000
1 027
995
Sénégal
original
générique
1 027
2003
2004
2005
2006
Stavudine, Lamivudine, Efavirenz
1 200
ppy $
2002
2 000
1 944
ppy $
Sénégal
original
générique
1 500
800
600
1 096
1 000
1 096
836
836
400
325
325
200
500
409
167
0
0
2001
2002
2003
2004
2005
2006
2001
2002
2003
2004
2005
2006
Conclusion (1)
Second-Line Costs
1/ Price evolution:
Therapeutic
Regimen
Cost - Generic
2006 (ppy $)
Cost - Senegal
2006 (ppy $)
TDF, ddI, L/r
853
1885
- Tenofovir (TDF): $258 /yr [Gilead access price: $207/yr]
- Lopinavir+rito (L/r): $1394 /yr [Abbot access price: $500/yr]
- Has followed world-wide evolution of decreases:
large drop in 2000–2001, then slower decrease since:
- Decreases are linked to generic supply,
- Current prices are close to the lowest prices existing
on the generic market
- Price of second-line therapies:
≈ $1800 /yr, 6 times more expensive / first line
- Second line ≈ 6 times more expensive than first line.
4
Conclusion (2)
2/ Constraints influencing ARV drug supply:
Changing therapeutic regimens
Product availability
Best prices
-> Drug supply cannot be solely based on pricing
***
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