Interesting new data on prices countries are paying on Hep C drugs was published yesterday in Lancet Global Health. The study shows strikingly, that some middle-income countries pay as much, if not more, than wealthy countries for hep C direct-acting antiviral drugs (DAAs).
This week in the open-access journal Lancet Global Health, authors from Médecins Sans Frontières (MSF) and from hospitals in Brazil and Pakistan have released data showing a very wide range of prices that countries pay for direct-acting antivirals (DAAs), used to treat hepatitis C. Prices varied substantially between low-, middle- and high-income countries, setting the price range and providing the lowest price that countries can currently ask for. Most striking was the finding that some middle-income countries are paying as much as – and in some cases, more than – high-income countries.
For example, middle-income countries Turkey and Malaysia are paying as much for the DAA combination ledipasivir/sofosbuvir as Switzerland does, and more than the UK, France and Italy. Malaysia also pays more for sofosbuvir than France, Italy or Spain – despite France, for example, having a gross national income (GNI) that is nearly 70% higher than Malaysia’s.
While low-income and most middle-income countries are generally paying relative to each other in terms of socio-economic status, there are also some outliers; South Africa pays six times more for simeprevir than Brazil, despite Brazil having a higher GNI. Similarly, Côte d’Ivoire – with a GNI almost half that of India – pays almost three times more for generic sofosbuvir than does India.
Turkey is among a group of middle-income countries that have been excluded from a voluntary licence which Gilead – the producer of sofosbuvir and sofosbuvir/ledipasvir – has signed with 11 generic manufacturers in India. The exclusion of many middle-income countries from the voluntary licence agreement means prices are unaffordable in these countries – where most of the global hepatitis C burden lies. These drugs are priced out of reach for many despite studies showing that the cost to produce them is just a small fraction of their price. Researchers at Liverpool University estimate that sofosbuvir, for example, costs just US$101 to produce per treatment course.
Generic competition has already seen prices of DAAs fall; in Egypt, a local generic version of sofosbuvir is available for around $350 per bottle and is expected to decrease to $100. Countries that are excluded from voluntary licences can nonetheless access low-cost generics by using internationally-recognised trade flexibilities, while generic sources of DAAs pre-qualified by World Health Organization will be essential to broaden access to affordable combinations.
The data is available in the Correspondence article, “Disparity in market prices for hepatitis C virus direct-acting drugs”, published in Lancet Global Health.