1. HIV Drug Treatment Expenditures at the Instituto Mexicano del Seguro Social (IMSS) Cuernavaca Morelos, Mx. August 1 st, 2008.

2. 2 Background  Antiretrovirals (ARVs) are essential for individuals who live with HIV, but they are the most expensive component of HIV care.  After the Ministry of Health (SSA), the IMSS is the second most important provider of ARVs in Mexico, with about 18,000 patients under treatment in 2006.  Since 2001, the IMSS has had universal free access to ARVs; nevertheless, information about ARV costs is scarce.

3. 3 Objective To provide empirical evidence on:  Institutional Purchasing Prices.  Total Expenditures on ARVs.  Average Expenditures per IMSS beneficiary under treatment.

4. 4 Methodology Identification of ARV purchased and their providers (2002-2006) through the IMSS Purchasing Database The nominal prices were deflated into constant prices, using 2006 as the base year. Calculation: ARVs Total Cost, Average Cost Per IMSS Beneficiary, per Therapeutic Group, and type of treatment First & Second Line (WHO) Regression Model For predicting future data

5. 5 Results  The purchasing prices for 28 ARVs exhibit a declining trend: median reduction was 11.9%.  Most of ARVs were bought from distributors, or from indirect providers (not directly from the labs).  The main distributors were:  Fármacos Especializados  Selecciones Médicas  Ralca

6. 6 Data Source: IMSS

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10. 10 Conclusions  The purchasing prices show a lightly decreasing trend.  There is a rising trend in the total expenditure on ARV.  There is also a rising trend in the expenditure per IMSS beneficiary under ARV treatment.  Hypotheses:  Changes into second-line treatment  Shortage reductions / Advanced purchasing  This is one of the very few empirical works about this subject.

11. 11 Limitations  The reliability of the database.  Short time-series.  Estimated number of beneficiaries (CENSIDA´s Information).  Nevertheless, first analysis of the only public-access source.

12. 12 Comments and Questions Rodrigo Medinilla rmedinilla@gmail.comrmedinilla@gmail.com, Omar Galárraga ogalarraga@insp.mxogalarraga@insp.mx, Veronika Wirtz vwirtz@insp.mxvwirtz@insp.mx.