Journal Article > CommentaryFull Text
Southern African Journal of HIV medicine. 1 March 2012
Andrieux-Meyer I, Clayden P, Collins S, Geffen N, Goemaere E, et al.
Southern African Journal of HIV medicine. 1 March 2012
Journal Article > CommentaryFull Text
Lancet. 1 October 2006; Volume 368 (Issue 9545); 1405-1406.; DOI:10.1016/S0140-6736(06)69584-6
Gillies R, von Schoen-Angerer T, 't Hoen E
Lancet. 1 October 2006; Volume 368 (Issue 9545); 1405-1406.; DOI:10.1016/S0140-6736(06)69584-6
Journal Article > ReviewFull Text
Global Health. 12 October 2011; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
Moon S, Jambert E, Childs M, von Schoen-Angerer T
Global Health. 12 October 2011; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
BACKGROUND
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Journal Article > CommentaryFull Text
Clin Infect Dis. 19 March 2012; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Ford NP, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T, et al.
Clin Infect Dis. 19 March 2012; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Journal Article > CommentaryAbstract
Lancet Infect Dis. 1 April 2011; Volume 11 (Issue 4); DOI:10.1016/S1473-3099(11)70036-6
Cox HS, Ford NP, Keshavjee S, McDermid C, von Schoen-Angerer T, et al.
Lancet Infect Dis. 1 April 2011; Volume 11 (Issue 4); DOI:10.1016/S1473-3099(11)70036-6
Journal Article > CommentaryFull Text
PLOS Med. 21 July 2009; Volume 6 (Issue 7); DOI:10.1371/journal.pmed.1000106
Moon S, Perez Casas C, Kindermans JM, de Smet M, von Schoen-Angerer T
PLOS Med. 21 July 2009; Volume 6 (Issue 7); DOI:10.1371/journal.pmed.1000106
Tido von Schoen-Angerer and colleagues discuss the new Affordable Medicines Facility for malaria (AMFm), which subsidizes and facilitates access to artemisinin-based combination therapy, and what mechanisms are needed to ensure it stays focused on quality patient care.
Journal Article > LetterFull Text
Lancet. 12 July 2003; Volume 362 (Issue 9378); 172.; DOI:10.1016/S0140-6736(03)13878-0
von Schoen-Angerer T
Lancet. 12 July 2003; Volume 362 (Issue 9378); 172.; DOI:10.1016/S0140-6736(03)13878-0
Journal Article > ResearchFull Text
Drug Discov Today. 1 July 2008; Volume 13 (Issue 13-14); DOI:10.1016/j.drudis.2008.04.009
van Roey J, von Schoen-Angerer T, Ford NP, Calmy A
Drug Discov Today. 1 July 2008; Volume 13 (Issue 13-14); DOI:10.1016/j.drudis.2008.04.009
Clinical trials are usually designed to meet registration requirements in developed countries, and do not always address key concerns for use in developing countries. Four late-stage investigational new drugs - rilpivirine, etravirine, raltegravir and maraviroc - show potential to improve antiretroviral therapy. However, a number of issues could limit their use in developing countries, including dose selection, treatment strategy, combination with other drugs, use in specific populations and reliance on expensive tests. Key research questions relevant for developing countries need to be answered early in the drug development process to ensure maximum benefit for the majority.
Journal Article > CommentaryFull Text
Int J Clin Pract. 15 July 2011; Volume 65 (Issue 8); DOI:10.1111/j.1742-1241.2011.02697.x
Maher D, von Schoen-Angerer T, Cohn J
Int J Clin Pract. 15 July 2011; Volume 65 (Issue 8); DOI:10.1111/j.1742-1241.2011.02697.x
Journal Article > LetterFull Text
Lancet. 1 March 2012; Volume 12 (Issue 3); DOI:10.1016/S1473-3099(12)70015-4
Cox HS, Ford NP, von Schoen-Angerer T
Lancet. 1 March 2012; Volume 12 (Issue 3); DOI:10.1016/S1473-3099(12)70015-4