Abstract
BackgroundPrevious studies have described expenditures for antiretroviral (ARV) medicines in Brazil through 2005. While prior studies examined overall expenditures, they have not have analyzed drug procurement data in order to describe the role of court litigation on access and pricing.MethodsARV drug procurement from private sector sources for the years 2004–2011 was obtained through the general procurement database of the Brazilian Federal Government (SIASG). Procurement was measured in Defined Daily Doses (DDD) per 1000 persons-under-treatment per day. Expenditures and price per DDD were calculated and expressed in U.S. Dollars. Justifications for ARV purchases were examined in order to determine the relationship between health litigation and incorporation into Brazil’s national treatment guidelines.ResultsDrug procurement of ARVs from private sources underwent marked expansion in 2005, peaked in 2009, and stabilized to 2008 levels by 2011. Expenditures followed procurement curves. Medications which were procured for the first time after 2007 cost more than medicines which were introduced before 2007. Judicial actions initially resulted in purchases of newer medications for a select number of patients in Brazil but ultimately expanded availability to a larger population through incorporation into the national treatment guidelines.ConclusionsDrug procurement and expenditures for ARVs in Brazil varied between 2004–2011. The procurement of some drugs from the private sector ceased after public manufacturers started producing them locally. Judicial demand has resulted in the incorporation of newer drugs into the national treatment guidelines. In order for the AIDS treatment program to remain sustainable, efforts should be pursued to reduce prices through generic drugs, price negotiation and other public health flexibilities such as compulsory licensing.
Highlights
Previous studies have described expenditures for antiretroviral (ARV) medicines in Brazil through 2005
We show drug procurement from the private sector expressed in number of Defined Daily Doses (DDD)/1000 personsunder-treatment/day according to WHO Anatomical Therapeutic Chemical Classification System (ATC) therapeutic class
Results of Judicial Action Our results indicate that the number of judicial actions is related to timing of incorporation into Brazil’s national treatment guidelines
Summary
Previous studies have described expenditures for antiretroviral (ARV) medicines in Brazil through 2005. While prior studies examined overall expenditures, they have not have analyzed drug procurement data in order to describe the role of court litigation on access and pricing. Patents for pharmaceutical products have been granted since 1997, authorities have been able to utilize public health flexibilities in order to decrease costs associated with treatment [5,6]. Between 2000 and 2004, overall expenditures for antiretroviral medications (ARVs) decreased, despite an increase in the number of people receiving ARVs. For example, between 2000 and 2004, overall expenditures for antiretroviral medications (ARVs) decreased, despite an increase in the number of people receiving ARVs This was mostly due to generic competition, negotiated price reductions with originator companies, and domestic production through Brazil’s public drug manufacturers [7]. In 2011, there were approximately 216,000 people on treatment, representing an estimated ART coverage of 72% [11]
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