Antiretrovirals Pricing:
The Past, The Present, The Future
Janice Lee
What did we learn from the past?
Price evolution of stavudine /lamivudine /nevirapine
>99% decrease
76% decrease
Prices of Improved First Line
Regimens At Present
Middle Income
Countries
First line, Second line,
Third line Prices At Present
No competition!
Untangling the Web
13th Edition
• Yearly MSF publication
since 2001 to provide
pricing of ARVs in response
to lack of transparent and
reliable information on
pricing of ARVs
• Used as lobby advocacy
tool, quotes in publication,
source of price comparison,
patent informations, access
issues
• One of the most
comprehensive pricing
information on originator
ARVs
• We are online:
utw.msfaccess.org
ARVs Cost Projections
• Next slides show price projections in 2014 by Clinton
Health Access Initiative (CHAI)
• Brazilian study showed that 55-99% of the direct
manufacturing costs of drug is represented by the active
pharmaceutical ingredient (API)1
• Prices are based on CHAI estimation of the products in a
commoditized generic market based on costing model
where API contributes 70% of the price. Cost estimate of
pipeline drug is based on triple FDC and not indicative of
single products. Do not address access related issues
other than long term cost in a competitive market
• Pipeline drugs are showed for the interest of price
comparison and more data is needed to determine its
safety and efficacy
1 Pinheiro
E, Vasan A, Kim JY, et al., Examining the production costs of
antiretroviral drugs. AIDS 2006, 20: 1745-1752
Projected Cost per Patient Per Year for Current and Pipeline NRTI
in 2014 (Price estimates courtesy of CHAI)
250
US$ per patient per year
200
200
150
91
100
65
50
24
30
12
6
0
TDF
AZT
d4T
3TC
ABC
Elvucitabine
Antiretrovirals
Elvucitabine is not yet marketed, in Phase II studies - Achillion
Projected Cost Per Patient Per Year for Current and Pipeline NNRTI
in 2014 (Price estimates courtesy of CHAI)
70
65
US$ per patient per year
60
50
40
37
30
15
20
7
10
0
NVP
EFV
Rilpivirine
Antiretrovirals
Rilpivirine is not yet marketed, in Phase III studies - Tibotec
Projected Cost Per Patient Per Year for Current and Pipeline PIs
and Integrase Inhibitors in 2014 (Price estimates courtesy of CHAI)
692
700
600
475
450
500
400
339
200
300
130
200
120
90
100
R
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V
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TV
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gr
av
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93
50
ir
0
r
US$ per patient per year
800
Antiretroviral
Elvitegravir and GS 9350 (cobicistat) is not yet marketed in Phase III
studies – Gilead
RAL and DVR pricing estimates are derived using conservative long term
estimates on anticipated generic API cost and reflect pricing in a
commoditized generic market
Potential Savings with Dose Optimization
**Cost savings
per patient per year in
US$
Drug
Current dose
*Target optimised
dose
AZT
300mg bid
200mg bid
3TC
300mg bid
150mg od
EFV
600mg od
400mg od
$ 31
$ 16
$ 23
LPV/r
400/100mg
bid
200/150 mg bid
$ 171
ATV/r
300/100mg
bid
200/100 mg OD
$ 85
DVR/r
600/100mg
bid
400/50 mg OD (PI
naives)
RAL
400mg bid
100 mg BID
*Source: Andrew Hill, **CHAI estimates
$ 252
$ 345
First line with TDF
US$176ppy
Second line with ATV+RTV
US$465ppy Third line with DRV+RTV+ETV+RAL
US$3204ppy
Drug regimen
Dose optimized 3-in-1 pill(s)
TDF 300mg+3TC 150mg+EFV 400mg OD
AZT 200mg BID+3TC 150mg OD+EFV 400mg OD
AZT 200mg BID+3TC 150mg OD+ATV/r 200/100mg OD
Dose optimized newer ARVs
RAL 100mg BID+ TDF 300mg OD+3TC 150mg OD
Elvitegravir 150mg+RTV 100mg+TDF 300mg+3TC
150mg
Dose optimized ARV in pipeline
TDF 300mg+ elvucitabine 10mg+ rilpivirine 25mg
TDF 300mg+ elvucitabine 10mg+EFV 400mg
*Price estimates courtesy of CHAI
*Price US$ ppy
$121
$116
$328
$180
$175
$76
$111
In an ideal world…
•
•
•
•
Cost optimized drugs
Generic competition
No intellectual property access barriers
Improve process chemistry of production
resulting in greater price reduction
Is there more to cost?
• Cost effectiveness studies are often used
as a guide to change a current regimen by
measuring the change in cost over the
change in health benefits
• MSF study in Lesotho analysed 943
patients comparing those started on TDF,
AZT and d4T based regimen and the cost
associated with treatment, monitoring,
hospitalisation, consultations
• Results on Oral Late Breaker, Session
Room 4, 11.00am-12.30pm tomorrow
Thank You
Acknowledgement:
Alexandra Calmy – University Hospital of Geneva
Andrew Hill – Liverpool University
David Ripin – Clinton Health Access Initiative
Untangling the Web team