Antiretroviral drug expenditure, pricing and judicial demand: an analysis of federal procurement data in Brazil from 2004–2011

BMC Public Health

Claudia GS Osorio-de-Castro¹  Aurélio Maia²  Mariana BC Ramos²  Maria A Oliveira¹  Jing Luo¹ 

[1] Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil;Ministry of Health, Brasilia, Brazil

关键词: Access to medicines;    Judicial demand;    Brazil;    HIV/AIDS;    Drug procurement;    Antiretroviral treatment;   

Others  :  1131553
DOI  :  10.1186/1471-2458-14-367

 received in 2013-03-18, accepted in 2014-04-02,  发布年份 2014

【 摘 要 】

Background

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.

Methods

ARV 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.

Results

Drug 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.

Conclusions

Drug 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.

【 授权许可】

   
2014 Luo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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