title: Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases.
abstract: OBJECTIVE
  To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment.
  
  
  METHODS
  We estimated the impact of global strategies to reduce ARV prices using data on 7253 procurement transactions (July 2002-October 2007) from databases hosted by WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
  
  
  RESULTS
  For 19 of 24 ARV dosage forms, we detected no association between price and volume purchased. For the other five ARVs, high-volume purchases were 4-21% less expensive than medium- or low-volume purchases. Nine of 13 generic ARVs were priced 6-36% lower when purchased under the Clinton Foundation HIV/AIDS Initiative (CHAI). Fifteen of 18 branded ARVs were priced 23-498% higher for differentially priced purchases compared with non-CHAI generic purchases. However, two branded, differentially priced ARVs were priced 63% and 73% lower, respectively, than generic non-CHAI equivalents.
  
  
  CONCLUSIONS
  Large purchase volumes did not necessarily result in lower ARV prices. Although current plans for pooled procurement will further increase purchase volumes, savings are uncertain and should be balanced against programmatic costs. Third-party negotiation by CHAI resulted in lower generic ARV prices. Generics were less expensive than differentially priced branded ARVs, except where little generic competition exists. Alternative strategies for reducing ARV prices, such as streamlining financial management systems, improving demand forecasting and removing barriers to generics, should be explored.
authors: Boston University School of Medicine, Boston, MA 02118, United States of America. bwaning@bu.edu
authors: Brenda
authors: B
authors: Waning
authors: Warren
authors: W
authors: Kaplan
authors: Alexis C
authors: AC
authors: King
authors: Danielle A
authors: DA
authors: Lawrence
authors: Hubert G
authors: HG
authors: Leufkens
authors: Matthew P
authors: MP
authors: Fox
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics*; D003132:Commerce / Q000191:economics / Q000639:trends*; D003363:Cost Control; D016208:Databases, Factual; D016527:Drug Costs / Q000639:trends; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D017008:Negotiating
chemical_list: D044966:Anti-Retroviral Agents