Unaffordable and unavailable: Newer ARVs in Thailand
A recent WHO evaluation predicted that by 2020, the cost of ART with second-line regimens could reach US$ 500 million per year in Thailand. Broad access to second line will only be viable if prices are reduced: the World Bank calculated that if cost of second-line falls to 10% of the current price, US$ 3.2 billion dollars will be saved over the next 20 years.
The new heat-stable version of lopinavir/ritonavir (LPV/r) remains too expensive and is not yet registered for use in Thailand. Rather than prioritizing registration of the new version of LPV/r - which is now standard in the West - Abbott has stated that Thailand can use the old version, even though it is a less desirable drug (a heat-stable drug is highly desired in a country where the average annual temperate exceeds 30 degree Celcius).
Moreover, the older version is still very expensive, currently costing around $2200 per patient per year, well in excess average annual wage of an office worker ($1450).
As of August 2006, Thailand had not formally adopted a national treatment protocol for second-line, but cost concerns are limiting which drugs can be considered. The current budget allocated to second-line may allow up to 1,600 people to be treated, which is far from the estimated 5,000 who will need second-line in 2006 alone.
The current lack of access to TDF and new LPV/r is likely to have long-lasting implications in Thailand. Because these drugs are not available at an affordable price, policy makers are forced to make decisions based on less desirable drugs. Treatment guidelines, once established, will be difficult to change.