Waning Brenda, Kaplan Warren, King Alexis C, Lawrence Danielle A, Leufkens Hubert G, Fox Matthew P
Boston University School of Medicine, Boston, MA 02118, United States of America.
Bull World Health Organ. 2009 Jul;87(7):520-8. doi: 10.2471/blt.08.058925.
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.
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.
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.
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.
评估全球战略（如集中采购安排、第三方价格谈判和差别定价）对降低抗逆转录病毒药物（ARV）价格的影响，目前抗逆转录病毒药物价格阻碍了艾滋病治疗的普及。
我们利用世界卫生组织和全球抗击艾滋病、结核病和疟疾基金数据库中7253笔采购交易（2002年7月至2007年10月）的数据，评估全球降低抗逆转录病毒药物价格战略的影响。
在24种抗逆转录病毒药物剂型中，有19种未发现价格与采购量之间的关联。对于其他5种抗逆转录病毒药物，大量采购比中量或少量采购便宜4%-21%。在克林顿基金会艾滋病倡议（CHAI）下采购时，13种仿制药中有9种价格低6%-36%。18种品牌抗逆转录病毒药物中有15种差别定价采购的价格比非CHAI仿制药采购高23%-498%。然而，两种差别定价的品牌抗逆转录病毒药物分别比非CHAI仿制药等效产品低63%和73%。
大量采购不一定能降低抗逆转录病毒药物价格。尽管目前的集中采购计划将进一步增加采购量，但节省的费用不确定，应与项目成本相平衡。CHAI进行的第三方谈判降低了仿制药抗逆转录病毒药物的价格。除了几乎没有仿制药竞争的情况外，仿制药比差别定价的品牌抗逆转录病毒药物便宜。应探索降低抗逆转录病毒药物价格的替代战略，如简化财务管理系统、改善需求预测和消除仿制药障碍。
