A recent study argued that although antiretroviral (ARV) treatment is available at relatively low prices in lowest income countries—those with gross national incomes (GNI) of less than US $1,025 per person per year—many middle-income countries with large HIV epidemics are paying very high prices because no established system exists for fair ARV pricing for these middle-income countries. In fact, no consistent correlation exists between drug prices and GNI for middle-income countries.
The study compared the cost of treatment with six key ARVs with the per capita annual GNI of countries in three income levels: low income, low-medium income, and medium income. The six low-income countries (GNI equal to or less than US $1,025 per person) were Ethiopia, Malawi, Uganda, Tanzania, Kenya, and Cambodia. The six low-medium countries (GNI US $1,026–$4,035 per person) were Nigeria, Vietnam, India, the Philippines, Indonesia, and Ukraine. The eight medium-income countries (GNI US $4,036–$12,475 per person) were Namibia, South Africa, Botswana, Thailand, China, Malaysia, Brazil, and Russia. The ARVs in the study included nevirapine, efavirenz, tenofovir, AZT/3TC, tenofovir/FTC, and lopinavir/ritonavir, including brand-name and generic versions.
The median cost of treatment per person per year in African higher middle-income countries for efavirenz (600 milligrams once daily) was US $60 (ranges US $51–$69), while in non-African countries the cost was US $241—four times higher. The price of efavirenz in non-African countries ranged from US $57 in Brazil to US $784 in Malaysia. The trend was the same for all the other ARVs the researchers examined. Malaysia, which had the third highest GNI of the medium-income countries, paid the highest price for ARVs, except for the drug tenofovir, for which Brazil paid the highest price.
Although upper-middle-income countries are expected to pay higher prices, the range in prices across upper-middle-income countries shows wide discrepancies. Dr. Andrew Hill, a senior research fellow in the Department of Pharmacology at the University of Liverpool and author of the study, concluded that a new ARV pricing system was necessary for all middle-income countries with large HIV epidemics.
The abstract, “Is the Pricing of Antiretrovirals Equitable? Analysis of Antiretroviral Drug Prices in 20 Low and Middle Income Countries,” was presented at the Seventh International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, June 30–July 3, 2013, in Kuala Lumpur, Malaysia, and is available online at http://pag.ias2013.org/Abstracts.aspx?SID=72&AID=3102.