Clinton Foundation secures price cuts for efavirenz, abacavir and rapid HIV tests

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The Clinton Foundation announced yesterday that it has reached agreement with generic drug manufacturers and makers of rapid HIV antibody tests for large reductions in the prices of efavirenz (Sustiva) and abacavir (Ziagen), and of rapid HIV antibody test kits.

The reduced prices will be dependent on ordering minimum volumes of drugs, and have been achieved as a result of negotiations by the Clinton Foundation with the manufacturers of the active pharmaceutical ingredients (APIs) needed to make the drugs.

Although presented as a cut in the cost of second-line treatment, the drug price cuts are likely to have little impact on the range of second-line options for resource-limited countries. Efavirenz cannot be used after the failure of the nevirapine (the core drug used in combination therapy in resource-limited settings), due to cross-resistance, and the utility of abacavir as a second-line drug is dubious unless switching takes place rapidly after viral load rebound, before the accumulation of nucleoside analogue resistance mutations.

Glossary

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

second-line treatment

The second preferred therapy for a particular condition, used after first-line treatment fails or if a person cannot tolerate first-line drugs.

first-line therapy

The regimen used when starting treatment for the first time.

nucleoside

A precursor to a building block of DNA or RNA. Nucleosides must be chemically changed into nucleotides before they can be used to make DNA or RNA. 

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the approximately 30 countries that are ranked as low income are in sub-Saharan Africa, many African countries including Kenya, Nigeria, South Africa and Zambia are in the middle-income brackets. 

The price cuts will also have only a modest impact on the choice of drugs available for first-line treatment in Africa. The deal announced yesterday offers efavirenz at a ceiling price of $240 a year, undercutting the current best price offered by patent holder Merck by 30%. The drug will be offered by Aspen Pharmacare in South Africa under voluntary license from Merck, and by Ranbaxy, Strides and Cipla in India. Efavirenz will remain substantially more expensive than nevirapine, but the price cut will make the drug more affordable for patients who need the drug if they cannot tolerate nevirapine.

Abacavir will be offered at a ceiling price of $440 a year by Indian manufacturer Cipla, which is likely to leave the drug on the shelf in the most resource-limited settings despite its widespread adoption as an element of first-line treatment in the developed world. Abacavir is now considered preferable to AZT or d4T in first-line treatment in the UK, for example, because it is not associated with disfiguring fat loss caused by the older nucleoside analogues.

However, the price reductions will be available to Latin America and other middle-income countries too, potentially widening the choice of treatment in those countries.

Rapid antibody testing

The reduction in the price of rapid antibody tests will have a substantial impact on the ability of national treatment programmes to scale up HIV diagnosis. Four companies—Chembio (U.S.), Orgenics (Israel; a subsidiary of Inverness Medical Innovations), Qualpro Diagnostics (India), and Shanghai Kehua (China)—will offer rapid tests for $0.49-$0.65 per test. According to the Clinton Foundation, market prices for rapid tests vary by region.

In Africa and other low-income countries, current prices range between $0.80 and $1.44 per test. In Latin America and among middle income countries, market prices are as high as $5 per test. Lower pricing is available from a number of smaller Asian suppliers but very few of these tests have been sold outside of Asia. CHAI’s prices range between $0.49 and $0.65.

In order to confirm that a person is HIV-positive, countries must run a combination of at least two different tests. Given current testing algorithms and prices in Africa, most governments are paying more than $2 per person identified as HIV-infected. Under CHAI’s new agreements, these countries will be able to adjust their algorithms to cut the cost of testing by 50%. In Latin America and other middle income countries the savings potential will exceed 50%.

Further information

Clinton Foundation Q & A on the price reductions

Clinton Foundation HIV/AIDS Initiative