Closing the Affordability Gap for Drugs in Low-Income Countries (New Eng Jour Med)

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Closing the Affordability Gap for Drugs in Low-Income Countries
Robert Steinbrook, M.D.

The cost of treating human immunodeficiency virus (HIV) infection is decreasing. Nonetheless, tenofovir–emtricitabine–efavirenz, the standard first-line treatment in North America and Europe, is prescribed rarely in low- and middle-income countries. The lowest annual cost for a generic formulation of this regimen is still hundreds of dollars more than the $100 annual cost of generic stavudine–lamivudine–nevirapine, an effective but less safe alternative that has been largely abandoned in Western countries (see Figure 1)

Unfortunately, many medications remain unaffordable in low- and middle-income countries. In the public sector, medicines are often provided free of charge, but essential drugs may be unavailable. If they were less expensive, governments could provide them to more patients and international drug aid would benefit more people. In the private sector, medicines are more available but not more affordable. One way to estimate affordability is to calculate the number of days the lowest-paid government employee would have to work to purchase a 1-month treatment regimen.2 The affordability of standard treatment for coronary heart disease in the private sector varies from less than 2 days' wages in Bangladesh and Sri Lanka to about 5 in Brazil, Nepal, and Pakistan to more than 18 in Malawi (see Figure 2). The affordability range of standard asthma and diabetes treatments is similar.

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Although there are many strategies for closing the affordability gap, each drug and disease poses unique challenges that require nuanced approaches. The experience with HIV medicines has called attention to the broader problem, but progress may come one drug at a time.

Source Information

Dr. Steinbrook ([email protected]) is a national correspondent for the Journal.

The New England Journal of Medicine is owned, published, and copyrighted © 2007 Massachusetts Medical Society. All rights reserved

http://content.nejm.org/cgi/content/full/357/20/1996?query=TOC