Delivery of HIV care in low income countries will continue to suffer due to the high cost of drugs, a new study warns.

The study, published in the Journal of Virus Eradication, raises questions about the fairness of pricing medicines of significant public health importance such as Dolutegravir (DTG), made by ViiV, which is majority owned by GlaxoSmithKline, with Pfizer and Japanese pharmaceutical company Shionogi as shareholders.

Led by Joel Sim, from the Faculty of Medicine at the Imperial College London, the study titled Is pricing of dolutegravir equitable?” highlights the wide disparity in prices of DTG across countries, even when compared across similar income levels.

In 2015, the World Health Organisation recommended the antiretroviral drug as an alternative first-line regimen for HIV-positive adults and adolescents. DTG has few side-effects (one small tablet taken daily), and patients are less likely to develop resistance.

The study recommends that the cost-effectiveness and the differences in marketed prices of DTG be re-evaluated given that the low-cost generic Efavirenz (EFV) has become widely available. The study extracted the prices of DTG from public national drug price databases of 52 countries, reimbursement authorities and WHO Global Price Reporting Mechanism in April last year.

The price was recorded as dollars per-person-year (ppy).

“We compared the price of DTG to minimum costs of production and reduced prices of EFV, and assessed the correlation with GDP per capita and HIV epidemic size in three income classification groups —high, upper middle and lower middle and low-income,” said Dr Sim.

The annual prices of DTG ranged from $27 per-person-year in Georgia to $20,130 in the US.  For the past two years, DTG has been used in high-income countries as the drug of choice for HIV/Aids patients, but was accessible to few people in low- and middle -income countries because of the pricing, until the generic version was introduced by WHO in 2017.

In East Africa, Kenya was the first country to introduce the generic DTG that July. A box of 30 pills, which lasts a month, cost between Ksh5,000 ($50) and Ksh6,000 ($60) while the generic version costs just $4.

Uganda switched to the drug in September last year. According to the report, the original DTG ppy in Uganda was $269 and $365 in Brazil. The median price of DTG in high-income countries across varying income levels is stable at around $9,042 ppy due to patent restrictions.