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Market Information Initiative - Boston University School of Medicine

Transitioning from stavudine (d4T) to tenofovir (TDF) and zidovudine (ZDV) in low and middle income countries. Market Information Initiative - Boston University School of Medicine International AIDS Society Conference 2012. Study objectives.

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Market Information Initiative - Boston University School of Medicine

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  1. Transitioning from stavudine (d4T) to tenofovir (TDF) and zidovudine (ZDV) in low and middle income countries Market Information Initiative - Boston University School of Medicine International AIDS Society Conference 2012 Larry Culpepper, MD, MPH; Ellen Dancel, PharmD, MPH; Paul G. Ashigbie, B.Pharm, MPH; NakeemaStefflbauer, PhD

  2. Study objectives • Describe how the volume of d4T, TDF, and ZDV product purchases have changed in LMICs since the 2009 WHO recommendations • Examine how the prices of these commodities have changed over the same period

  3. Introduction • d4T: Back bone of 1st line regimens • 60% of patients on d4T (Renad-Thery 2007) • d4T products: Lowest price FDC-2008 (Glob. and Health) • Withdrawal of d4T in adult regimens (WHO 2009) • Replacements: TDF and ZDV based regimens

  4. Method • Analyzed pooled procurement data from the MII database at BU • Data sources: - WHO Global Price Reporting Mechanism (GPRM), - Global Fund Price Quality Report (PQR), - UNITAID. - Partnership for Supply Chain Management Systems (PFSCMS) /President’s Emergency Fund for AIDS Relief (PEPFAR)

  5. Method

  6. Results Volume (person years) and value (USD) of purchases: Global

  7. Results: Low income countries

  8. ResultsLower middle income countries

  9. ResultsUpper middle income countries

  10. Results: % countries purchasing each group of products by year

  11. Results: Median prices (USD) of annual treatments for 3-in-1 FDC and co-packed d4T, ZDV and TDF products

  12. Results: Trends in the patronage of 3-n-1 FDCs (volume in person years) Note: “Pct” refers to the proportion of 3-in-1 FDC sales relative to non 3-in-1 FDCs in each category of products (d4T, ZDV or TDF preparations)

  13. Conclusion • Transition from d4T to ZDV and TDF has been slow • Transition seems to be at a relatively higher rate in middle income countries • No preference for 3-in-1 TDF based regimens • Prices of 3-in-1 FDCs of TDF stagnated despite increased volume of purchases

  14. Thank you

  15. Acknowledgments • Bill and Melinda Gates Foundation – Sponsor • Clinton Health Access Initiative – Partner • Jenny Hochstadt – Boston University • Nathan Blalock – Boston University

  16. Annex • Stavudine Formulations • lamivudine 150mg / nevirapine 200mg / stavudine 30mg • lamivudine 150mg / stavudine 30mg • stavudine 30mg • stavudine 40mg • Zidovudine Formulations • abacavir 300mg / lamivudine 150mg / zidovudine 300mg • efavirenz 300mg + lamivudine 150mg / zidovudine 300mg • efavirenz 600mg + lamivudine 150mg / zidovudine 300mg • lamivudine 150mg / nevirapine 200mg / zidovudine 300mg • lamivudine 150mg / zidovudine 300mg • zidovudine 300mg • Tenofovir Formulations • efavirenz 600mg / emtricitabine 200mg / tenofovir 300mg • efavirenz 600mg / lamivudine 300mg / tenofovir 300mg • emtricitabine 200mg / tenofovir 300mg • lamivudine 300mg / tenofovir 300mg • tenofovir 300mg

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