Brazil conference spotlights cost of hepatitis C drugs

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For $50 (R699) patients around the world have been cured of the once deemed incurable disease hepatitis C. However, the same cure would cost $10,000 (R140,000) in the private sector in South Africa and in the US the price is $100,000 (R1.4m). The Times reports that new data released at the World Hepatitis Summit held in Sao Paulo‚ Brazil‚ this week shone a spotlight on one of the most controversial areas of medicine pricing: hepatitis C drugs.

University of Cape Town hepatology professor Mark Sonderup said doctors have treated more than 150 hepatitis C patients at Cape Town’s Groote Schuur Hospital using the new drugs. Nearly all have been cured in 12 weeks. The two drugs are not licensed in South Africa but can be imported under a special permit. The generics of Sofosbuvir and Daclatasvir can also be accessed. Sonderup estimates the drugs cost $10,000 in the private sector and in the public sector go for $1,000 for a 12-week course. He said there was “room for improvement in prices”.

The report says University of Liverpool pharmacologist Andrew Hill explained at the summit that a tandem of drugs‚ Sofosbuvir and Daclatasvir‚ used together as a cure for hepatitis C have widely discrepant prices in different countries. The two drugs cost about $78 in India‚ $174 in Egypt‚ $6,000 in Australia‚ $77,000 in the UK‚ and $96,404 the US. In some countries‚ people who cannot afford the first world prices of the medicines join together to make “international buyer’s clubs” and import generics from manufacturing countries in order to be cured.

Hill explained that manufacture of the drugs‚ the active ingredients‚ the packaging costs and a tiny profit margin came to about $50 per course.

The report says Hill’s study looked at 1,160 patients who imported the generic drugs in 88 countries. The cure rate was above 90%‚ almost the same rate as the original expensive products. His point was that generic drugs can provide a cure for about 70m people with the hepatitis variant worldwide‚ but remain out of reach for most because of high prices.

The hepatitis drug debate has really brought the global debate on medicine pricing into the spotlight‚ The Lancet Commissions Report on Medicines reported in 2016. It was estimated that treating all patients with hepatitis C in the US would cost $65bn over five years. The cost of $84,000 just for Sofosbuvir in the US even lead to an investigation by US Senate Committee of Finance.

Paying for these drugs has tremendous “budget implications” in high-income countries – but in poor countries‚ prices are “even more daunting”‚ said The Lancet’s report. Sofosbuvir was invented at a university but brought to market by a private biotech firm with the skills to do so. The Lancet estimated it only cost them $200m to do this. The firm was bought by Gilead Sciences for $11bn.

According to the report, the Lancet Essential Medicines report revealed that “within 1 year of introducing the medicine (Sofosbuvir)‚ Gilead Sciences had recouped the initial expenditure of $11.2bn; the patent will not expire before 2024”. This patent on Sofosbuvir means prices will not come down for the cure in every country even though Gilead has recouped its investment.

In South Africa‚ the Treatment Action Campaign has called for discussion and law changes where medicine patents render life-saving medicines out of reach‚ especially where patents are extended in South Africa above 20 years as can be the case.

The Times report
World Hepatitis Summit
The Lancet Essentials Medicines report 2016

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