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Abstract
Pharmaceutical patents and access to HIV/AIDS treatments: the Brazilian experience
C.M. Meiners1, J. Chauveau2, S. Luchini3, J.-P. Moatti2, ANRS / ETAPSUD
1Ministry of Health, Brasilia, Brazil, 2INSERM-U379 / ORS-PACA, Marseille, France, 3GREQAM / EHESS, Marseille, France
Background: Among Developing Countries, Brazil has pioneered in providing free and universal access to antiretroviral (ARV) therapies. Brazilian procurement strategy for ARV has been a key element to lower drug prices and to allow success of its programme. This paper conducts econometric analyses on determinants of HIV/AIDS drugs prices in Brazil in order to better understand the pricing mechanism for these drugs.
Methods: Retrospective data on real ARV transactions purchased on behalf of the Brazilian National STD/AIDS Programme between 1998 and 2002 were collected. For every transaction, source prices and quantities were recorded as well as precise characteristics of drug, involved parties and context of transaction. Descriptive analyses were done using price per daily dose (PDD). Logarithms of PDD were used as the dependent variable in multiple linear regression model with the characteristics of products, transactions and contexts being used as explanatory variables.
Results: An overall 65.1% decrease of mean PDD has been observed between 1998 and 2002. If all drugs have experienced such an evolution, the number of off-patent interchangeable drugs within a therapeutic class has an important downward effect on prices whilst drugs belonging to more recent therapeutic classes remain more expensive. b-estimates of multivariate analyses confirm a significant price difference between therapeutic classes as well as a significant impact on prices of both feasibility of drug substitution and patent protection. It also highlights the role played by generic competition in Brazil (-0.236).
Conclusions: Generic competition generated by local ARV production has been a key determinant of ARV price decrease. Nevertheless, ARV drugs still account for almost half of the total cost of the whole Brazilian AIDS programme. Issues regarding intellectual property rights remain crucial to allow long term sustainability of price reduction and access to most recent therapeutic advances in Brazil.
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