title: Antiretroviral drug expenditure, pricing and judicial demand: an analysis of federal procurement data in Brazil from 2004-2011.
abstract: BACKGROUND
  Previous studies have described expenditures for antiretroviral (ARV) medicines in Brazil through 2005. While prior studies examined overall expenditures, they have not have analyzed drug procurement data in order to describe the role of court litigation on access and pricing.
  
  
  METHODS
  ARV drug procurement from private sector sources for the years 2004-2011 was obtained through the general procurement database of the Brazilian Federal Government (SIASG). Procurement was measured in Defined Daily Doses (DDD) per 1000 persons-under-treatment per day. Expenditures and price per DDD were calculated and expressed in U.S. Dollars. Justifications for ARV purchases were examined in order to determine the relationship between health litigation and incorporation into Brazil's national treatment guidelines.
  
  
  RESULTS
  Drug procurement of ARVs from private sources underwent marked expansion in 2005, peaked in 2009, and stabilized to 2008 levels by 2011. Expenditures followed procurement curves. Medications which were procured for the first time after 2007 cost more than medicines which were introduced before 2007. Judicial actions initially resulted in purchases of newer medications for a select number of patients in Brazil but ultimately expanded availability to a larger population through incorporation into the national treatment guidelines.
  
  
  CONCLUSIONS
  Drug procurement and expenditures for ARVs in Brazil varied between 2004-2011. The procurement of some drugs from the private sector ceased after public manufacturers started producing them locally. Judicial demand has resulted in the incorporation of newer drugs into the national treatment guidelines. In order for the AIDS treatment program to remain sustainable, efforts should be pursued to reduce prices through generic drugs, price negotiation and other public health flexibilities such as compulsory licensing.
authors.forename: Jing
authors.initials: J
authors.lastname: Luo
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oliveira
authors.forename: Mariana B C
authors.initials: MB
authors.lastname: Ramos
authors.forename: Aurélio
authors.initials: A
authors.lastname: Maia
authors.affiliation: Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. claudia.osorio@ensp.fiocruz.br.
authors.forename: Claudia G S
authors.initials: CG
authors.lastname: Osorio-de-Castro
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D001938:Brazil; D003132:Commerce; D016527:Drug Costs / Q000331:legislation & jurisprudence*; D016568:Drugs, Generic / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D005102:Health Expenditures; D006801:Humans; D017008:Negotiating; D017149:Private Sector / Q000191:economics*; D014481:United States
chemical_list: D019380:Anti-HIV Agents; D016568:Drugs, Generic
references.citation: AIDS. 2009 Nov 13;23(17):2289-300
references.pmid: 19710593
references.citation: Lancet. 2009 Jun 27;373(9682):2182-4
references.pmid: 19560587
references.citation: Rev Saude Publica. 2007 Apr;41(2):214-22
references.pmid: 17384795
references.citation: AIDS. 2002 Dec 6;16(18):2373-83
references.pmid: 12461410
references.citation: Am J Public Health. 2005 Jul;95(7):1110-6
references.pmid: 15933238
references.citation: AIDS. 2007 Jul;21 Suppl 4:S21-9
references.pmid: 17620749
references.citation: N Engl J Med. 2006 May 11;354(19):1977-81
references.pmid: 16687709
references.citation: Cad Saude Publica. 2005 Mar-Apr;21(2):525-34
references.pmid: 15905915
references.citation: AIDS. 2007 Jul;21 Suppl 4:S37-45
references.pmid: 17620751
references.citation: Rev Saude Publica. 2006 Apr;40 Suppl:60-9
references.pmid: 16729160
references.citation: Rev Saude Publica. 2011 Aug;45(4):714-21
references.pmid: 21739079
references.citation: PLoS One. 2011;6(8):e23478
references.pmid: 21858138
references.citation: AIDS. 2004 Jun;18 Suppl 3:S5-7
references.pmid: 15322477
references.citation: Health Aff (Millwood). 2009 Jul-Aug;28(4):1103-13
references.pmid: 19597210
references.citation: Bull World Health Organ. 2004 Nov;82(11):815-21
references.pmid: 15640916
references.citation: PLoS Med. 2007 Nov 13;4(11):e305
references.pmid: 18001145
references.citation: Lancet. 2002 Dec 7;360(9348):1862-5
references.pmid: 12480377