Center for Health System Research, National Institute of Public Health, Mexico.
BMC Public Health. 2009 Nov 18;9 Suppl 1(Suppl 1):S6. doi: 10.1186/1471-2458-9-S1-S6.
Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs.
An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs.
Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief.
One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.
抗逆转录病毒药物（ARV）是艾滋病毒/艾滋病治疗中最昂贵的部分之一。许多国家正在努力为所有艾滋病毒感染者和艾滋病患者提供普遍获得 ARV 的机会。尽管 ARV 的价格大幅降低，特别是在 2002 年至 2008 年期间，但在未来几十年实现可持续获得仍然是大多数低收入和中等收入国家面临的主要挑战。本研究的目的有两个：首先，分析 2005 年至 2008 年全球 ARV 价格及其相关因素，特别是采购方法和关键捐助者关于 ARV 采购效率的政策；其次，讨论在实施或改革获取 ARV 方案时应考虑的采购程序和政策选择。
利用世界卫生组织全球价格报告机制对 ARV 药物价格进行了分析。选择了 12 种 ARV 药物，计算了全球中位数价格和价格变化。对每种 ARV 药物都使用线性回归模型来确定与较低采购价格相关的因素。使用逻辑回归模型确定了采购价格低于最高和最低直接制造成本的国家的特征。
有三个关键因素似乎对一个国家的 ARV 价格有影响：（a）产品是否为仿制药；（b）国家的社会经济地位；（c）国家是否为克林顿艾滋病倡议成员。不会影响以最高直接制造成本以下价格进行采购的因素包括艾滋病毒流行率、采购量、国家是否属于最不发达国家或美国总统艾滋病紧急救援计划的重点国家。
在未来几十年内帮助降低 ARV 价格的主要机制之一是提高采购效率。基准价格可能是实现这一目标的有用工具之一。
