Download proposal title here second line carol bellamy 20 november 2002

ENSURING SECURE and RELIABLE
SUPPLY and DISTRIBUTION SYSTEMS in DEVELOPING
COUNTRIES, in the CONTEXT OF HIV/AIDS and PMTCT
Paediatric ARV Formulations
Demand, Supply, Costs –
impact on the availability of formulations ….
Geneva
November 2004
Helene Möller
M.Pharm, PhD
Supply Division
Nov 2004
Access to Paediatric ARV formulations
Access to paediatric ARV formulations depends on
effective supply chain management
Demand
Product
Selection
Monitoring
Effective
Use
Forecasting
Receipt,
Storage,
Distribution
Financing
Product
Procurement
Quality
Assurance
Supplier
Agreements
Nov 2004
Access to Paediatric ARV formulations
FIRST LINE / PMTCT
ARV Formulations are available ……
Treatment
PMTCT/
1st Line
Products available
Price (US $ / 100ml)
Innovator
Generic
D4T
Yes
No
4.23 – 18.66
ZDV
Yes
Yes
2.96
1.53 - 2.10
3TC
Yes
Yes
2.80
1.68 - 2.00
NVP
Yes
Yes #
8.75
2.00 - 2.45
EFV
Yes
No
* Mostly current ACCESS prices unless range indicated , #
Nov 2004
Innovator * Generic #
9.45 - 15.12
Not necessarily WHO prequalified
Access to Paediatric ARV formulations
SECOND LINE / PMTCT
ARV Formulations are available ……
Treatment
Products available
Price (US $ / 100ml)
2nd Line
Innovator Generic Innovator *
ABC
Yes
No
13.05
ddI
Yes
No
9.64
LPV/r
Yes
No
13.70 – 136.70
NFV
Yes
No
35.00 / 144g
* Mostly current ACCESS prices unless range indicated , #
Nov 2004
Generic #
Not necessarily WHO prequalified
Access to Paediatric ARV formulations
MSF Paper: Current situation regarding prices and
availability of specific children formulations …
• Cost of treatment drops when switching to
adult formulations:
Peak around 14kg bodyweight
• Using tablets for a child (20 kg) reduces the
cost per treatment per year nearly 8 times:
– (d4T / 3TC / NVP )
Best generic price/y
Best innovator price/y
$ 566
$1,706
$224
$631
• Managing the switch – increases complexities
in resource poor settings
Nov 2004
Access to Paediatric ARV formulations
ARV liquid formulations can become expensive ..
Cost per month
Regimen
Paediatric
Cost per day
original generic original
generic
Total Cost / y
original generic
ZDV+3TC+
NVP (±3kg)
21.69
16.91
0.72
0.56
256.32
200.67
ZDV syr
+3TC+NVP
(±10kg)
53.61
43.35
1.79
1.44
637.24
514.36
ZDV caps
+3TC+NVP
(±10kg)
24.94
18.35
0.83
0.61
Nov 2004
295.48
Access to Paediatric ARV formulations
217.75
PREVENTION :
Appropriate formulations to provide the infant dose ….
• For Prevention of Mother to Child
Transmission:
For infant:
Zidovudine (ZDV)
Nevirapine (NVP)
Lamivudine (3TC)
Nov 2004
4mg/kg 2x daily, for 1 week, 4-6 weeks
single dose 0,6ml
2mg/kg 2x daily, for 1 week
Access to Paediatric ARV formulations
PREVENTION :
Appropriate formulations to provide the infant dose ….
PMTCT formulations
Product
Cost ( $ )
per
per
formulation
dose
pack
dose
nevirapine
nevirapine
0.6ml
zidovudine
zidovudine
(generic)
BAXA syringe
2,5ml bd, 7d
20ml
free
free
240ml
0.22
17.50
200ml
1.78*
7.10*
100ml
0.77
1.53
( free with donation )
0.25
* Price incl delivery
Nov 2004
Access to Paediatric ARV formulations
Are there other costs that affect the
price / cost of
Paediatric ARV Formulations
?
Nov 2004
Access to Paediatric ARV formulations
Other cost factors to consider …
• Minimum order quantities:
Nelfinavir
Abacavir, etc
CHF 10,000
24 bottles per order
• The pipeline : Balancing lead times, holding stock,
emergency stock needs
– need to develop local drug supply strategies to prevent
hoarding, expiry and potential stock outs
– procedures for accessing ‘emergency’ supplies need to be
clear to all
• What about distribution costs ? Shipping ?
• What about costs to the patient ?
Nov 2004
Access to Paediatric ARV formulations
Access to paediatric ARV formulations depends on
effective supply chain management
Demand
Creation
Product
Selection
Monitoring
We need
partners
to
complete
the cycle
Effective
Use
Forecasting
Receipt,
Storage,
Distribution
Financing
Product
Procurement
Quality
Assurance
Supplier
Agreements
Nov 2004
Access to Paediatric ARV formulations