title: Modeling HIV/AIDS drug price determinants in Brazil: is generic competition a myth?
abstract: BACKGROUND
  Brazil became the first developing country to guarantee free and universal access to HIV/AIDS treatment, with antiretroviral drugs (ARVs) being delivered to nearly 190,000 patients. The analysis of ARV price evolution and market dynamics in Brazil can help anticipate issues soon to afflict other developing countries, as the 2010 revision of the World Health Organization guidelines shifts demand towards more expensive treatments, and, at the same time, current evolution of international legislation and trade agreements on intellectual property rights may reduce availability of generic drugs for HIV care.
  
  
  RESULTS
  Our analyses are based on effective prices paid for ARV procurement in Brazil between 1996 and 2009. Data panel structure was exploited to gather ex-ante and ex-post information and address various sources of statistical bias. In-difference estimation offered in-depth information on ARV market characteristics which significantly influence prices. Although overall ARV prices follow a declining trend, changing characteristics in the generic segment help explain recent increase in generic ARV prices. Our results show that generic suppliers are more likely to respond to factors influencing demand size and market competition, while originator suppliers tend to set prices strategically to offset compulsory licensing threats and generic competition.
  
  
  CONCLUSIONS
  In order to guarantee the long term sustainability of access to antiretroviral treatment, our findings highlight the importance of preserving and stimulating generic market dynamics to sustain developing countries' bargaining power in price negotiations undertaken with originator companies.
authors.affiliation: Economic and Social Sciences, Health Systems and Society (SE4S), UMR 912 (INSERM, IRD, Aix-Marseille University), Marseille, France. constance.meiners@inserm.fr
authors.forename: Constance
authors.initials: C
authors.lastname: Meiners
authors.forename: Luis
authors.initials: L
authors.lastname: Sagaon-Teyssier
authors.forename: Lia
authors.initials: L
authors.lastname: Hasenclever
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics; D000465:Algorithms; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D001938:Brazil; D016527:Drug Costs / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D004345:Drug Industry / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D040541:Marketing / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D018803:Models, Economic; D011640:Public Policy; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents; D016568:Drugs, Generic