|Uganda Ministry of Health - UNAIDS HIV/AIDS Drug Access Initiative - Preliminary Report (UNAIDS, 2000, 14 p.)|
The current costs of commonly used drug combinations are summarized below. To better represent drug costs in the context of the Ugandan economy, roughly estimated monthly salaries of some government positions and the monthly per capita GNP have been included.
Cost of 30 days supply of Combinations of Antiretrovirals in Relation to Typical Salaries in Uganda. Feb 2000
Figure Legend: ZDV = zidovudine (Retrovir), DDI = didanosine (Videx), Com = Zidovudine/Lamivudine (Combivir), D4T = stavudine (Zerit), EFV = efavirenz (Stocrin), IDV = indinavir (Crixivan), NFV = nelfinavir (Viracept), RIT = ritonavir (Norvir), SAQ = saquinavir (Invirase).
Fluctuations in the costs of drugs to the patient
Since the beginning of the initiative, the costs of drugs have changed because 1) new drug products became available, 2) purchase prices from the pharmaceutical manufacturers changed, and 3) the value of the Uganda shilling changed in reference to the major foreign currencies. Six of the first seven price changes occurred due to a currency devaluation, followed by a rise in currency valuation. The rapid currency devaluation resulted in an estimated 20% increase in drug costs to the patient. During this time, some patients were reported to have had treatment interruptions due to their inability to meet the sudden increase in cost in local currency. Changes in drug prices in local currency are summarized below:
Figure 3. Antiretroviral Costs in Response to Currency Valuation. Uganda, 1999.
On an individual patient level, these currency fluctuations may have dramatic short-term or long-term effects on the affordability of drugs and, thus, sustainability of therapy. Regardless, there are many other factors that influence the affordability of drugs by an individual not examined here, including inconsistent income and competing household expenses. The approximate mark-up of 6% at Medical Access Ltd. and the treatment centers is small in comparison to the potential for cost fluctuations due to currency devaluation.
In May 2000, five pharmaceutical firms announced that they will further decrease the prices of antiretroviral drugs. The price of one drug product, Combivir, has been announced to be approximately $60 for a 30-day supply. This is 28% of the price that was available in Uganda during early 2000. It is expected that these lower prices will enable more patients to access antiretroviral drugs in Uganda. However, these costs need to be considered in the context of typical incomes of Ugandans, where average per capita Gross National Product (GNP) is approximately $26 per month, making antiretroviral therapy out of reach for the vast majority of persons living with HIV/AIDS in Uganda. It is also important to note that the cost of drugs is only a small component of the health care costs that must be met by the patient. Costs of CD4+ and viral load monitoring, medical visits, and diagnosis, prophylaxis, and treatment of AIDS-related illnesses must also be considered. Costs for training, expansion of laboratory capacity, and other infrastructure needs are additional costs that must also be addressed.