Evolution of the costs of anti-retroviral drugs in developing countries over the past decade: A systematic review

Tolulope Oshiba, The University of Texas School of Public Health


As of 2011, over 34 million people lived with HIV/AIDS, and about 95 percent of this population lived in low- and middle-income countries. Despite the emergence of antiretroviral drugs (ARVs) over the past decade as a powerful force for saving lives in these nations, the incidence rate for HIV/AIDS remains overwhelmingly high. For instance, sub-Saharan Africa is reported to be the worst affected region, with almost 26 million young people infected with the virus. In part, the extremely high incidence rate in the past was due to the fact that pharmaceutical companies charged very high prices for ARVs in low- and middle-income countries. Notwithstanding, times have changed and the prices for ARVs have dropped sharply over the last ten years in developing countries. The reduced costs have been driven by various factors such as the manufacture of generic ARVs, price negotiation, differential pricing, bulk purchases, and compulsory licensing. This paper reviewed the literature for studies on the evolution of the costs of ARVs in developing countries over the past decade, specifically, in middle and low income countries from the year 2000 to the present. The databases searched in this systematic review were: Ovid Medline (R) and PubMed (National Library of Medicine). Out of a total of 172 articles initially identified, only 3 were rated by two independent raters as being of high quality, and were selected for final abstraction, synthesis and evidence weighting. Results from these 3 studies suggest that, in low- and middle-income countries, the reduction of ARV costs has been largely driven by the increased production of generics by generic manufacturers and the use of third-party price negotiations. It also came to light that the major rationale behind the drastic reductions in ARV prices is due to the fact that most nations of the world are united in the fight against HIV/AIDS, and they are proving this by trying to deliver ARV access to PLWHA globally by making these drugs affordable. Just like in high-income nations, there is suggestive evidence in the literature that generic ARVs and price negotiation with pharmaceutical companies play a significant role in reducing ARV costs for people living with HIV/AIDS in low- and middle-income countries. Therefore, effective strategies for reducing ARV prices, in addition to present ones, should be explored in order to help to continue to lower prices drastically. To continue to reduce the costs of ARVs in these nations, stakeholders should encourage quality generic ARV production by local drug companies, and be flexible regarding restrictions and laws that are aimed at transferring technology to generic producers in countries that have the capacity to locally produce ARVs. Also, as newer and more effective ARVs emerge, it is important to sustain the momentum of the fight against HIV/AIDS, and every strategy that is found to be effective must be improved to help PLWHA in low- and middle-income countries.

Subject Area

Medicine|Public health|Health care management

Recommended Citation

Oshiba, Tolulope, "Evolution of the costs of anti-retroviral drugs in developing countries over the past decade: A systematic review" (2013). Texas Medical Center Dissertations (via ProQuest). AAI1549926.