ARV Drug Combinations | Innovator Companies | Estimated Cost per Year (US$)a | Comments |
Current WHO-Recommended ARV Regimens for Adults | |||
Efavirenz + TDF + lamivudine or emtricitabine (Atripla is a comparable pill marketed in the US) | NA (generic available) | $122 |
|
Lopinavir/ritonavir or atazanavir/ritonavir + zidovudineb + lamivudine | NA (generic available) | $305–$318 |
|
Highly Effective Alternatives, Not Ideal for Resource-Limited Settings | |||
Elvitegravir + TDF + emtricitabine + cobicistat (Stribild, the “quad” pill) | Gilead | $184 |
|
Dolutegravir + abacavir + lamivudine (Triumeq, the “tri” pill) | ViiV | $179 |
|
Illustrative Improved (Hypothetical) 3-Drug Regimens | |||
Dolutegravir + TAF + lamivudine or emtricitabine | ViiV + Gilead | $60 |
|
Dolutegravir + boosted protease inhibitor + TAF | ViiV + Gilead + Others | $266–$357 (or morec) |
|
Dolutegravir + TAF + doravirine | ViiV + Gilead + Merck | $64 |
|
Illustrative Improved (Hypothetical) 2-Drug Maintenance Combinations (for use after undetectable viral load achieved) | |||
Dolutegravir + rilpivirine | ViiV + Janssen | <$40 |
|
Cabotegravir + rilpivirine (long-acting injectable) | ViiV + Janssen | $40 |
|
Dolutegravir + doravirine | ViiV + Merck | $50 |
|
Dolutegravir + lamivudine | ViiV | $46 |
|
Dolutegravir + TAF | ViiV + Gilead | $39 |
|
Dolutegravir + boosted protease inhibitor | ViiV + Others | $252–$343 (or morec) |
|
Abbreviations: ARV, antiretroviral; NA, not applicable; TAF, tenofovir alafenamide fumarate; TB, tuberculosis; TDF, tenofovir disoproxil fumarate; WHO, World Health Organization.
↵a For approved and available ARVs, these costs were based upon the generic prices from the Supply Chain Management Systems E-catalog, November 2014 version.4 Costs do not include in-country logistic and storage costs. While these prices are more than the manufacturing cost, they are used as a proxy for the fully loaded costs, given that the generic market is competitive with a relatively low profit margin. For hypothetical ARV combinations, illustrative manufacturing costs were estimated as follows: (1) rilpivirine oral or injectable: $15, based upon expert consultation,6 and assuming cost of oral rilpivirine ≤ cost of injectable; (2) dolutegravir oral: $25, based upon expert consultation,6 and assuming cost of oral dolutegravir ≤ cost of injectable; (3) cabotegravir injectable: $25, assumed to be same cost as dolutegravir injectable and given similar structure of the 2 compounds; (4) TAF: $14 assumes TAF costs 1/3 of TDF at approximately 1/10 the dose; (5) cobicistat: $90; in the absence of other data, cost assumed to be the same as another pharmacokinetic booster, ritonavir25; and (6) elvitegravir (150 mg/day) and doravirine (100 mg/day), both assumed to cost $25 per year to manufacture in the absence of other data. Note that the costs for these hypothetical ARVs are solely meant to provide a sense of the degree of savings that might be possible; actual costs may be substantially higher or lower than these estimates.
↵b WHO recommends that in cases in which zidovudine has been used in a first-line regimen, TDF should be included in the second-line regimen rather than zidovudine.
↵c Darunavir/ritonavir has the most robust resistance barrier of any boosted protease inhibitor but is not currently as widely available as a generic as lopinavir/ritonavir or atazanavir/ritonavir. Darunavir/ritonavir may be somewhat more expensive to manufacture.