Transcript US price - AfroCAB

TREATING 35 MILLION
PEOPLE WITH ART –
WHERE ARE WE?
Andrew Hill
St Stephens AIDS Trust
Chelsea and Westminster Hospital
London, UK
Estimating minimum costs of treatment
1.HIV: Using publicly available databases on costs of treatment in lowincome countries (e.g. Clinton Foundation, Medicins Sans Frontieres). HIV
2.Hepatitis B, TB and Cancer: Tracking import-export databases to find
costs of API (Active Pharmaceutical Ingredient – drug substance before
formulation and packaging). Then add costs of final formulation and profit
margin using established methods.
3.Hepatitis C: First principles: evaluating routes of chemical synthesis,
retrosynthesis, costing of raw materials (sub-units of drugs).
Collaboration with experts in chemical synthesis and mass production of
medicines to evaluate prices. Cross-checks using different methods.
Entecavir for Hepatitis B
one year’s supply (0.2g)
Entecavir for Hepatitis B
cost per person/year by country
Entecavir (Baraclude)
US price: $15,111
Cost price: $36
Total exported volumes equivalent to
344,000 12-week courses
Estimating minimum costs of sofosbuvir
Cost of API =
$1,209/kg
API needed per person = 34g (400mg x 84 days)
API per 12
weeks = $40
Formulation = 40%
Formulated drug
= $56
Packaging = $0.35/month
Packaged drug =
$58
Final generic
price = $86
Profit margin = 50%
$ 84,000
US price: $84,000
$ 10,000
$ 86
$ 20,000
Target
$ 6,875
$ 27,921
Portugal
$ 30,000
$ 27,921
$ 44,689
Canada
$ 40,000
Spain
$ 46,139
Germany
$ 50,000
$ 46,139
$ 60,000
France
$ 53,010
$ 70,000
$ 897
Cost price: $86
$ 80,000
India
$ 90,000
Brazil
UK
$0
USA
price in USD for 12-week treatment course
Current costs of sofosbuvir, by country
12 week course of treatment
Sofosbuvir (Sovaldi)
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Total exported volumes equivalent
to 373,000 12-week courses
Estimating minimum costs of daclatasvir
Cost of API =
$1,377/kg
API needed per person = 5g (60mg x 84 days)
API per 12
weeks = $6.9
Formulation = 40%
Formulated drug
= $10
Packaging = $0.35/month
Packaged drug =
$11
Final generic
price = $16
Profit margin = 50%
Current costs of daclatasvir, by country
12 week course of treatment
$ 63,000
$75,000
US price: $63,000
Cost price: $16
$ 37,152
$ 35,174
Spain
$45,000
UK
$ 39,387
$60,000
$ 16
Target
Brazil
France
$0
$ 276
$ 2,552
$15,000
India
$30,000
USA
price in USD for 12-week treatment course
Daclatasvir (Dakinza)
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Hepatitis C buyers clubs
There are many companies willing to export generic
DAAs into Europe / North America
Generic sofosbuvir can be bought online in 15 minutes,
for approx. $1200 per course. Prices falling rapidly.
But what about quality?
We need systems in place to ensure that supplies are
from accredited generic manufacturers
The FixHepC Buyers Club (www.fixhepc.com)
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Published SVR12 Results SOF+LDV and SOF+DCV
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REDEMPTION-1 Overall SVR4 Results For Generics
Note: Some small percentage loss of SVR is expected during the SVR4 to SVR12 period
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0
$62
$19
$12
$7
$9
$3
GDF Catalogue (generic)
India (nonSRA generic)
Low-demand target price
High-demand target price
$38
Russia (generic)
$82
France (generic)
$86
South Africa (generic)
100
Thailand (Bayer)
$106
Spain (generic)
UK (Bayer)
US (generic)
US (Bayer)
price in USD per month
Price of Moxifloxacin by country
900
$806
800
Moxifloxacin
700
US price: $806
600
500
Cost price: $6
400
300
$232
200
0
500
$70
$17
$13
$5
India (nonSRA-generic)
High Target
Low Target
$150
India (SRA-generic)
GDF Catalogue (generic)
$711
Russia (generic)
1000
Russia (Pfizer)
1500
South Africa (Pfizer)
$2,011
UK (Pfizer)
2000
Spain (Pfizer)
4500
US (Pfizer)
price in USD per month
Price of Linezolid by country
$4,298
4000
3500
3000
2500
$1,862
$1,246
$690
Treatments for Cancer
Basic 20-year patents on six Tyrosine Kinase Inhibitors (TKIs)
expire by 2020:
Imatinib
Ibrutinib
Erlotinib
Sorafanib
Sunitinib
Lapatinib
Simple chemical structure, oral dosing, dose range 100-1000mg/day
Import / export API prices used to estimate minimum production costs
Compared with quotes from approved suppliers and national prices
Lowest available price for Imatinib (400mg) in selected countries
$ 120,000
$ 106,322
Imatinib (Gleevec)
Price per year (USD)
$ 100,000
US price: $106,322
$ 80,000
Cost price: $180
$ 60,000
$ 40,000
$ 35,216 $ 34,482
$ 31,867
$ 28,675
$ 20,877
$ 20,000
$ 8,370
$ 8,192
$ 790
$0
$ 180
Drug
Major indication
Target
price
Indian price (or
other lowest if
Indian not
available)
US price
Imatinib
Chronic Myeloid
Leukaemia
$172
$803
$107,799
Erlotinib
Non-Small Cell Lung
Cancer
$240
$1932
$79891
Sorafenib
Renal Cell Carcinoma
$1450
$1332
$139,138
Lapatinib
Breast Cancer
$4020
$18,603 (Thailand)
$75161
Cabazitaxel
Metastatic prostate
cancer
$666
$30,810 (South
Africa)
$120,613
Dasatinib
Chronic Myeloid
Leukaemia
$15
$1183 (Brazil)
$10,408
Pazopanib
Renal Cell Carcinoma
$116
$1463 (Brazil)
$8412
Gefitinib
Non-Small Cell Lung
Cancer
$16
$139
$6728
Capecitabin
Metastatic Colorectal
$73
$126 (Latvia)
$1941
The new $90 $90 $90
There could be standard prices for HIV, Hepatitis B
and Hepatitis C in low/middle income countries.
Worldwide:
$90 per year to treat HIV
$90 per year to treat Hepatitis B
$90 for a 12 week course of treatment to cure Hepatitis C
Universal access to HIV treatment is one of the
greatest success stories in medicine (>15 million treated).
This should not stand alone, but be repeated for
mass treatment of cancer, viral hepatitis and other diseases
– this time, more quickly
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