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New $90-$90-$90 target needed for global viral hepatitis, HIV and TB treatment
Keith Alcorn, 2016-10-24 23:00:00

The costs of making drugs to treat viral hepatitis, HIV and TB are now so low that each disease could be treated for less than $90, Dr Andrew Hill of St Stephen’s AIDS Trust told the opening plenary of the International Congress on Drug Therapy in HIV Infection in Glasgow on Sunday.

The cost of generic drugs to cure TB is already below $90 for a six-month treatment course, and some antiretroviral regimens for HIV treatment have already fallen below $90 a year in lower-income countries. The cost of generic treatment for hepatitis B and C is also falling, Dr Hill said, with potential for further reductions.

By the end of 2017 it should be possible to treat HIV for the same price in South Africa and in Europe, but hepatitis C treatment will remain very expensive in higher-income markets, Dr Hill explained, unless pharmaceutical companies agree to lower the prices of direct-acting antivirals in return for agreements on treating larger numbers of patients, as in Australia.

A collapse in the cost of raw materials to manufacture the hepatitis C direct-acting antivirals sofosbuvir and daclatasvir due to economies of scale has driven down the feasible price of profitable manufacture of a 12-week course of treatment to $76 and of sofosbuvir/ledipasvir to $96, Dr Hill told the conference.

Sofosbuvir alone is currently sold by Gilead Sciences for 50,426 euros in Germany, the highest-priced market outside the United States.

Hill’s research group is able to project the lowest-possible manufacturing cost by analysing trends in costs of shipments of active pharmaceutical ingredients (API), the raw material of drug manufacture, in and out of India. By calculating the amount of API needed to make a course of treatment, adding $0.04 per tablet for excipients and tableting and $0.35 for the cost of formulation, and then adding a 10 - 50% profit margin, the researchers can calculate the minimum price a generic manufacturer could make a drug for.

The price of sofosbuvir API has fallen from around $9,000 per kg in January 2015 to around $1000 per kg in August 2016.

The hepatitis B drug entecavir could be manufactured for a price of $36 for a year’s treatment, and will go off patent in 2017, while tenofovir/lamivudine could be manufactured for $67 a year, implying a hepatitis B treatment cost also below $90 a year.