The cost of ARVs
Who remembers the days when it was only the privileged that had access to ARVs? They would have relatives and friends send them drugs from overseas. I recall friends ferrying brown envelopes on board flights from the UK. ARVs were either not available in Malawi or just not affordable in the pharmacy for the common man.
But times have thankfully changed for the better! Short of the occasional stock outs, the question for most is not whether they have access to ARVs but whether they are getting the best ones…that will be the topic for next time but today…how much do ARVs actually cost?
In 2002, 904 patients at Queen Elizabeth Central Hospital and Kamuzu Central Hospital and 316 at Chiradzulu hospital were on Highly Active Anti-Retroviral Therapy (HAART). By the end of March 2012, 347,983 in Malawi were receiving ARV treatment. The reduction in drug prices from over $10,000 (K3.4 million at the current exchange rate) in early 2000 to on average less than $100 (K34,000) has been a turning point in the treatment and care of people with HIV.
A number of factors have lead to the drop in the cost of ARVs: pressure from activists, competitive prices from generic manufacturers, and consortiums and governments negotiating with pharmaceutical companies. Cheaper drug prices have made it possible for eight million people to access ARVs in developing countries around the world. In the late 1990s, the cost of drugs in the USA was about $10,000 -$15,000 (K5.1 million) per person per year. An impossible sum for low income countries.
In early 2000s, there was a major breakthrough when an Indian pharmaceutical company began production on generic drugs which are the same as the big pharmaceutical companies (big pharma), but much cheaper. Generic drugs are identical to the branded or proprietary drug but cheaper. They have the same drug composition, safety, strength and performance as their expensive branded cousins.
A price war between big pharma and the generic drug companies lead to big pharma reducing the price of their drugs. When Cipla, an Indian generic pharmaceutical company, first brought their triple combination ARV on the market in mid 2000s it was $800 (K272,000) whilst big pharma were charging $10439 (K3.5 million). Mounting pressure from governments, lobbying groups, and organization like the Clinton Foundation for reduction in prices led to further cuts by mid 2001, the generic drugs from India cost $295 (K100, 300) per person per year.
The cost of drugs continued to decline by 30 to close to 70% in the mid to late 2000s. The combination of choice at the time was stavudine (d4T)+lamivudine (3TC)+nevirapine (NVP) cost on average $64. But stavudine was found to cause serious side effects and the World Health Organization recommended phasing it out. In July 2012, Malawi signed a MK64. 7 billion (US$201.8 million) grant from the Global Fund to Fight AIDS, TB, and Malaria to assist with the drug transition.
