people), but it is affordable for many, and governments generally have been able to afford that price (or find external financing) for their public-sector needs. Multiply the per-dose difference in price by the millions or tens of million courses used per year in each country in Africa, and the money adds up. Continent-wide, an estimated 200-400 million courses of treatment are used per year, and an additional 100 million courses in the rest of the world. Realistically, the endemic countries are able to contribute very little of the incremental cost, and that is not likely to change for many years, given the pace of economic development in Africa and in poor nations elsewhere. One positive change that is almost certain, however, is that several different ACTs will become available,2 and their price will come down by more than half, to about 10 times the current price of chloroquine, or about US$1 per adult course and US$0.60 for an average child’s course.

The Cost of Producing ACTs and Future Prices

Why are ACTs so much more expensive than chloroquine? Even at prices anticipated after the massive scale-up that would be necessary to supply the African market—should funding become available for large-scale purchase—the price as sold by the producer will likely remain at about 10 times the price of chloroquine (Table 2-1 lists prices offered by major producers to Médecins Sans Frontières [MSF] in 2003). These prices reflect the production costs of artemisinins without a premium for any exclusivity related to patents.3 They are high because the process involves growing the source plant, Artemisia annua, extracting the active moiety, and creating the desired artemisinin derivative (artesunate, artemether, etc.). Coformulation with the companion drug follows. The price of the finished product is driven mainly by the cost of the artemisinin derivative, but also is affected by the companion drug (e.g., lumefantrine, the companion drug in Coartem, is a relatively expensive drug on its own, which contributes to the high price of the coformulation).

There is something of a chicken-and-egg quality about the current price of artemisinins, and the prospect for significantly lower prices. Lower prices can be expected in response to large-scale demand, which, in turn, will induce competition among producers. However, without assurances from the global community that there will be a market for large quantities of


There are several companion drugs with which the artemisinin may be combined, and the development work on these new combinations is due to be completed within the next 2 years.


Coartem has some patent protection, but Novartis is selling it in developing countries for less than production costs, i.e., at a loss.

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