The Expert Committee on the Use of Essential Drugs 12th Meeting
15-19 April 2002

Comments and data on price and availability of antiretroviral drugs

Médecins sans Frontières, 8 April 2002

Following and attached are MSF comments on WHO's recommendations for changes to the model EDL and updates on prices and availability of ARV sources (these reflect changes that occurred after WHO made their submissions to the committee). Please, see up-dated prices and sources as of 7th April 2002, which are detailed in excel file attached. 

NNRTIs

We suggest listing also nevirapine -NVP- for the additional indication of HIV/AIDS treatment in combination therapy, instead of listing only efavirenz -EFV- as an example of the therapeutic class (NVP is included in the WHO Model List of Essential Drugs No.11 for the indication of Mother-to-child transmission only). Main arguments:

  • Absence of substantive difference in terms of safety and efficacy between EFV and NVP

  • NVP is proposed as an alternative for EFV in the recommended first-line regimen of WHO according to Hammer S et al. WHO Antiretroviral Guidelines for Resource Limited Settings. WHO Publications ( -in preparation)

  • It is already included in many national protocols as first-line therapy

  • There are cheaper sources available for NVP than for EFV (one of the generic sources of NVP has already been pre-qualified by the WHO project on pre-qualification of HIV/AIDS related drugs)

  • The cost per year per patient attributed to the NNRTI compound of a triple combination increase more than 4 fold when NVP is replaced by EFV.

PIs :  please, see tables attached for changes in price/availability

NRTIS : please, see tables attached for changes in price/availability

Fixed Dose Combinations (FDC): We suggest that the Committee include a formal recommendation (in the form of an explanatory note) in the new list concerning the the advantages of using fixed dose combinations when possible

There are already a number of FDCs available from both proprietary and generic pharmaceutical companies. We believe that if this recommendation is formalized through the Expert Committee, it will boost the production of appropriate FDCs (i.e. FDCs containing the ARVs included in the WHO Essential Drug List) 

Submitted by Carmen Pèrez-Casas, MsCPharm, Pharmaceutical Coordinator, Access to Essential Drugs Campaign, Médecins Sans Frontières, Carmen.Perez@madrid.msf.org, 7th April 2002

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