In 2017 there were 68.5 million people worldwide with HCV infection, less 1.5 million who were cured. There were 1.6 million new infections. At the current rate of treatment, achieving elimination of HCV is impossible.
The major barrier to elimination of the disease is the cost of Direct Acting Antivirals ( DAAs). DAA drug sales for 2014-18 are estimated at US$77 Billion. Gilead’s net profits in 2017 were US$13.5 Billion. This is on a background of an ongoing marked drop in the cost of the active pharmaceutical ingredient ( API)or raw drug substance (RDS). Currently the cost of 1kg Sofosbuvir is $981, enough for treating 30 patients ( $33 per course). For Daklastasvir $750 for treating 190 patients ($4 per course). The final generic cost of a cure with Sofosbuvir/Ledipasvir is $64 which compares with the USA cost of $142,710! Compare this with Australia where the government negotiated a price of around $6500 (in the USA Gilead have also released a generic form for $24,000).
Clearly, we can only eliminate HCV if we have access to affordable treatments.
Andrew accuses the pharmaceutical companies of greed and says “enough is enough”. He encourages countries to negotiate aggressively for better prices from them. He proposes challenging drug patents or issuing compulsory licenses so as to enable importation of bio-equivalent generic DAAs. This would give access to inexpensive treatments and also help drive down pharmaceutical company prices. He is confident that affordable medication costs will enable more countries to commit to HCV treatment and control programs.
As Andrew stated, HCV could have already been eliminated if the money that has already been paid to pharmaceutical companies for DAA’s at “ridiculously” high prices had been used to buy active pharmaceutical ingredient generic drugs. We have a remarkable cure in DAA medications. Now let’s follow through and achieve elimination of this lethal and stigmatizing disease by making it available to everyone.
Author bio: Dr Jane Hunt is a GP working in high case-load HIV practice at Holdsworth House Medical Practice (HHMP) in Darlinghurst N.S.W.
