Ed from court cases over time and compared these actions with
Ed from court cases over time and compared these actions with both bulk purchases and the dates of incorporation of each medicine into the national treatment guidelines [19]. We expressed prices of individual drugs using price per DDD (in U.S. Dollars). The price per DDD is a better approximation of treatment prices than price per tablet because the DDD is based on the average PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26437915 adult daily dose. To calculate price per DDD, we summed each ARV in grams and then divided that sum by the listed DDD for the particular drug to obtain the total number of DDDs purchased. We then divided the total amount spent for that drug in a given year by the total number of DDDs to obtain price per DDD. We show individual drug pricing for select ARVs only from 2007 onwards because many novel ARVs were not procured in Brazil prior to 2007, PNPP biological activity making it difficult to compare prices of ARVs from 2004 to 2007. Furthermore, 2007 was a landmark year in Brazil’s national treatment program because of the issuance of a compulsory license for efavirenz. Calculations and graphs were made with the help of Excel (Microsoft Corp. 2010). Expenditures were calculated by multiplying unit price by volume purchased. Costs were expressed in U.S. Dollars using mean annual exchange rates provided by the U.S. Federal Reserve Bank [20].Results Overall, our database of ARVs included 21 different medications in 40 dosage forms. There were only two fixed dose combination ARV medications: lopinavir/ritonavir and zidovudine/lamivudine. Individual purchases ranged from as few as three units (tipranavir in 2006) to as many as 106,080,000 units (lopinavir 200 mg/ritonavir 50 mg in 2011). The results of our descriptive analysis of the SIASG database are shown in Figure 1. This figure shows drug procurement from the private sector expressed in number of DDDs/1000 persons-Luo et al. BMC Public Health 2014, 14:367 http://www.biomedcentral.com/1471-2458/14/Page 3 ofFigure 1 Drug Procurement and total expenditures for antiretroviral medicines in Brazil from 2004?011. Volume procured expressed as DDD/1000 persons-under-treatment/day.under-treatment/day according to WHO ATC therapeutic class. It also shows annual federal expenditures for privately procured ARVs in U.S. dollars from 2004 ?2011.Procurement in DDDs per 1000 persons under treatment per dayOverall drug procurement rose dramatically from a low of 124 DDDs/1000 persons-under-treatment/day in 2004 to 929 DDDs/1000 persons-under-treatment/day in 2005. While procurement from the private sector involved all three major classes: nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) from the years 2004 until 2006, by 2007 the procurement of NNRTIs fell drastically and PIs became the predominant class of medications procured from the private sector by the federal government. This trend continued in subsequent years (with the exception of 2008, where a large purchase of tenofovir resulted in higher number of DDDs/1000 persons-under-treatment/ PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28300835 day of NRTIs when compared to PIs). In 2008, the government began to procure newer classes of drugs such as integrase inhibitors (raltegravir), entry inhibitors (maraviroc) and fusion inhibitors (enfurvitide). In 2010, there was a significant reduction in overall drug procurement from the private sector (from 1534 DDDs/ 1000 persons-under-treatment/day to 238 DDDs/1000 persons-under-treatment/day), which was likely due to the.
