The cost of living

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11 Jun 2014

There are calls worldwide for effective new hepatitis C drugs to be made more widely affordable. In the US, one such drug —sofosbuvir — developed by Gilead Sciences costs US$84,000 for a 12-week course of treatment (that’s US$1,000 a pill).

With sales of more than US$2.3bn so far, sofosbuvir has already sold more than any other drug in its first quarter on the market; analysts predict that figure could reach US$10bn by the end of the year. Other companies, including Bristol-Meyers Squibb and AbbieVie, are developing similar drugs with similar profit expectations.

Until recently, drugs to treat the hepatitis C virus (HCV) had a dismal record of success. They also came accompanied with such brutal side effects that doctors advised patients not to take up treatment until absolutely necessary. In stark contrast the new generation of HCV drugs — known as direct-acting antivirals (DAAs) — have been found to have up to 95% cure rates, with little-to-no side effects.

The development of DAAs coincides with a dramatic rise in terminal liver disease. “Liver cancer associated with hepatitis C is the most rapidly growing cancer in the Western world,” Professor Geoff McCaughan, one of Australia’s leading hepatologists, told the ABC. 

Hepatitis C is a common coinfection among people living with HIV. Worldwide, up to five million PLHIV also have HCV . This co-infection causes rapid progression of liver disease and mortality. Professor McCaughan is lobbying hard for the new class of HCV drugs to be subsidised, especially for the most vulnerable. He is not alone.

In February, activists from 22 countries convened in Bangkok to demand equitable access to the new drugs. Doctors without Borders is also lobbying for affordable access. Meanwhile, US lawmakers have called on Gilead to justify the price of sofosbuvir. In an open letter to the company, a group of Democrat Congressmembers wrote: “Our concern is that a treatment will not cure patients if they cannot afford it.”

In response, Gilead says, considering the drug’s effectiveness, the price is more than reasonable. The company argues that, in the long run, sofosbuvir provides value for money as it’s a one-off cost offering a lifetime cure. Gilead also points to the fact that sofosbuvir is available at a reduced price of around $900 per course in a number of low-income countries such as India, Kenya and Mozambique.

But according to Andrew Hill of the Department of Pharmacology and Therapeutics at the University of Liverpool, sofosbuvir costs per treatment as little as $150 to produce. While the drug may be available to low-income countries at 1.1% of the standard price, the reduced cost is still an impressive mark-up. “If the current high prices continue, it is likely that very few people will be treated and the overall epidemic of hepatitis C will continue,” said Hill.

The controversy surrounding the pricing of the new HCV drugs echoes the fight a decade ago for HIV drugs to be made more widely affordable. Back then, the cost of antiretrovirals meant people living in developing countries were often denied treatment. Today, because of competition from generic drug companies, HIV-positive people in low- and middle-income countries are able to afford life-saving treatment.

More than 350,000 people are estimated to die from hepatitis C -related liver diseases each year. Dr Stefan Wiktor, head of the global hepatitis program at the World Health Organisation, believes that without affordable HCV drugs people will die unnecessarily. “People are dying from liver cancer, from cirrhosis,” he said, “and these deaths can be prevented."