Info Service on Health Issues (Oct15/09)
Below is a blog highlighting a new study published in the Lancet that concludes some middle income such as Malaysia and Turkey are paying much more for DAA than developed countries.
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 M้decins Sans Fronti่res (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, C๔te 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.