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Further cuts in drug prices make tenofovir more affordable for low-income countries
Keith Alcorn, 2011-05-17 17:20:00

UNITAID, the international drug purchase fund, and the Clinton Health Access Initiative have announced further price reductions for key antiretroviral drug regimens, including a 14% reduction in the price of tenofovir-based triple combination therapy, to $159 a year.

The reduced prices will be available to over 70 low- and middle-income countries that form part of the CHAI Procurement Consortium, and have been negotiated with a range of generic drug manufacturers.

In part, prices have been pushed lower because of collaboration between pharmaceutical chemists employed by CHAI and generic drug manufacturers, designed to identify ways in which some drugs can be made more cheaply. This work was funded by the United Kingdom government’s Department for International Development.

Reductions in the cost of raw materials has also helped; identifying a new supplier for a key ingredient of tenofovir knocked $15 off the annual cost of tenofovir.

However, it is the prospect of larger guaranteed orders that has galvanised most manufacturers to offer lower prices for new drugs.

World Health Organization guidelines, updated in late 2009, now recommend that wherever possible, people with HIV should start treatment with a tenofovir-based three-drug combination. If that is too expensive, national treatment programmes should use AZT-based combinations, which are less toxic than the d4T-based combinations widely used in the early years of treatment scale-up.

The main price reductions include:

• A reduction in the price of tenofovir-based first-line treatment to $159 a year, down from $400 in 2008, and down 14% in the last year;
• A reduction in the price of a protease inhibitor-based second-line treatment regimen, to $410 a year.

CHAI said that it expects the cost of tenofovir-based treatment to fall below the cost of twice-daily AZT-based treatment within the next few years as demand grows. It projects that demand for tenofovir-based treatment will grow from one million patients in 2010 (18% of the first-line market) to 4.2 million in 2013 (53% of the first-line market).

The World Health Organization recommends that second-line antiretroviral treatment should be protease inhibitor-based, using either atazanavir or lopinavir boosted with ritonavir.

The partners also announced that a co-packaged combination of atazanavir, heat-stable ritonavir, tenofovir and 3TC will soon be available as second-line treatment, subject to approval by the US Food and Drug Administration and the World Health Organization, at a price of $395 a year.

In comparison lopinavir, coformulated with ritonavir, will be available at a generic price of $399 a year without tenofovir and 3TC.

CHAI said it anticipated a rapid switch to atazanavir when the new price becomes available, and further significant reductions in cost as demand grows. (See full price list here.)

Switches in drug regimens that drive costs lower will also have the effect of freeing up money to treat new patients. The partners estimate that price reductions could enable an extra 500,00 people to be treated, although this figure assumes that countries would have switched to new drugs without the incentive of price reductions.

However, even without any new enrolment of patients on treatment, the UK Department for International Development estimates that the effort to drive down prices by UNITAID and CHAI will result in savings of $600 million over the next three years when compared with 2008 prices. If treatment scale-up continues at the same pace as over the past three years, the scale of savings could reach $1 billion by 2014.