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Section: Guyana
October 2006

Ecuador Achieves a Significant Reduction in Antiretroviral Prices

By Lidice López
Asociación Agua Buena

Ecuador achieved a significant reduction in the price of antiretroviral drugs procured through an international purchase made in coordination with the Strategic Fund of the Pan American Health Organization (PAHO) [1].

As official sources at PAHO [2] indicate, the Fund developed special policies in coordination with the Global Fund to Fight AIDS, Tuberculosis, and Malaria to help beneficiaries comply with the administrative requirements of the Global Fund. Thus, by purchasing significant volumes of drugs directly from the manufacturers, the Fund is able to negotiate price reductions for the products to be acquired.

As a result of the Global Fund project, at the end of last year (2006) Ecuador purchased antiretrovirals for the health services program for people living with HIV/AIDS (PLHA) through the PAHO Strategic Fund; this enabled it to procure the drugs at prices well below those paid on earlier occasions (see table for details).

In the case of the regimen comprised of zidovudine, lamivudine, and efavirenz (AZT+3TC+EFV), used by 70% of the PLHA under treatment in Ecuador[3], Ecuador’s National AIDS Program (PNS) went from paying US$1,053.63 per treatment/year in 2006 to US$343.44 per treatment/year at the beginning of 2007; that is, a discount of approximately 68%. However, the most significant change occurred in the regimen comprised of stavudine, lamivudine, and efavirenz (D4T+3TC+EFV), used as an alternative to the first regime for cases of zidovudine intolerance (presence of anemia), when an 89% discount (from US$2,598.80 to US$290.64 per treatment/year) was obtained.

While the main reason for the price reduction was the procurement of generic drugs prequalified by WHO instead of brand-name drugs, there has also been a significant reduction in one of the drugs used for second-line (or rescue) schemes. In the case of Kaletra (lopinavir/ritonavir), the presence of a generic version on the market and world pressure led its manufacturer, Abbott Laboratories, to cut the price by nearly 50%. In this case, it was not necessary to opt for the generic alternative.

Table 1.—Comparative prices of antiretrovirals. Ecuador.

Lowest Price
Reference: 2006
Highest price
Reference: 2006
Price 2006
Price 2007
AZT + 3TC + Nevirapine 221.19 (Belize) 751.90 (El Salvador) - 178.80
AZT + 3TC + Indinavir 752.75 (Guatemala) 1,909.68 (El Salvador) - 1,156.00
AZT + 3TC + Efavirenz 362.75 (Peru) 1,417.05 (El Salvador) 1,053.63 343.44
d4T + 3TC + Neviraprine 121.07/127.36 * (Peru) 1,881.94 (El Salvador) - 112.80/ 116.40 *
d4T + 3TC+ Efavirenz 242.58 (Peru) 2,598.80 (Ecuador) 2,598.80 285.84/ 290.64 *
d4T + 3TC + Indinavir 686.93 (Belize) 3,039.72 (El Salvador) - 1,099.2/ 1104.00 *
d4T 40 + Ddi + Nevirapine 316.71 (Peru) 3,832.87 (El Salvador) - -
AZT + 3TC + Abacavir 761.45 (Peru) - - 742.20
AZT + 3TC + Lop/Rtv 2,230.43 (Peru) 5,637.43 (El Salvador) 4,426.23 2,347.80
D4T+ 3TC +Lop/Rtv 2,110.26 (Peru) 6,767.47 (El Salvador) 5,971.40 2,290.00/ 2295.00
Ddi+ 3TC+ NVP 338.05 (Peru) 2,615.23 (El Salvador) - -
AZT+ 3TC+ Nelfinavir 1,399.41 (Honduras) 4,780.69 (El Salvador) 3,512.92 2,131.80
3TC + Didannosine +
2,311.29 (Peru) 7,500.75 (El Salvador) 5,314.40 -

· Prices correspond to the combinations in fixed doses of D4T 30 mg and 40 mg, respectively.

Even though this price reduction augurs a significant increase in access to antiretroviral treatment in Ecuador , its sustainability is still not clear. The Ministry of Public Health (MPH) has yet not formalized a permanent agreement with the PAHO Strategic Fund that will enable it to continue purchasing antiretrovirals through the Fund. If that agreement does not materialize, Ecuador could once again pay the high prices it was paying up until last year, moving away of accessible prices and, thus, universal access to ARV treatment.

Ecuador ’s current situation suggests operational alternatives for accessing quality drugs at lower prices. This example should be followed by other countries such as Nicaragua , Panama , and El Salvador , whose purchases in 2006 were at prices above the average for Latin America.

 [1] PAHO Regional Revolving Fund for Strategic Health Supplies .

 [2] Idem

 [3] Source: Interview of the technical team of Ecuador ’s National AIDS Program.

Asociación Agua Buena
Richard Stern
Tel-Fax 506-2280-3548

Lidice Lopez
Tel: 51-1-346-2523

Eugene Schiff


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