amfAR, The Foundation for AIDS Research

When Drugs Cost as Much as Diamonds

Millions lack access to lifesaving treatment for hepatitis C

About 71 million people worldwide are currently infected with hepatitis C (HCV), according to the World Health Organization, and approximately 400,000 die each year as a result of HCV infection, primarily from cirrhosis and liver cancer.1 But why are there so many deaths when today's direct-acting antiviral drugs (DAAs) can cure more than 95% of infected people with a 12-week course of medicine?

The fact is that most people with HCV still do not have access to testing, diagnostics, and treatment. This uneven and inadequate access to lifesaving DAAs was a major theme of this year's International Liver Congress in Amsterdam, April 19-23. This annual meeting of the European Association for the Study of the Liver (EASL) brought together 10,000 scientific and medical experts from across the world to discuss the latest advances in liver research.

Generic_Hep_C_medsLeft to right: Dr. Andrew Hill, University of Liverpool, UK; Dr. James Freeman, FixHepC, Hobart, Australia; Mr. Giten Khwairakpam, TREAT Asia

"There is wide variability throughout countries of the Asia-Pacific region in the availability, registration status, and price of generic and brand-name DAAs," said Giten Khwairakpam, TREAT Asia's project manager of community and policy, in a presentation during the community summit held prior to the main congress. "Whether you can get specific DAAs, and how much you will have to pay for them, depends on where you live."

diamonds and daclatasvir5 gm each of diamonds (left) and the active ingredient of daclatasvir (right).
Photo: Dr. Andrew Hill
"It remains one of the greatest tragedies of modern times that these lifesaving drugs are not being deployed on a mass scale," said Dr. James Freeman of FixHepC in Hobart, Australia, during his presentation at the Amsterdam conference. Dr. Freeman pointed out that 5 grams of the brand-name version of the DAA daclatasvir, which can be part of a 12-week curative course of treatment, costs $50,000 at UK prices, the same as 5 grams of diamonds. But a similar supply of generic DAAs can be made for under $100. Mr. Khwairakpam was a co-author of this presentation.

Dr. Freeman highlighted the REDEMPTION-1 study, which demonstrated the effectiveness of generic HCV DAAs. Since and including REDEMPTION-1, data have been collected on 1,160 patients receiving generic drugs in 240 locations-including hospitals, clinics, and private doctors' offices-in 88 countries in 5 continents. The drugs have come from suppliers in India, Bangladesh, China, and Egypt.

"It remains one of the greatest tragedies of modern times that these lifesaving drugs are not being deployed on a mass scale."

"While there has been great progress in getting high quality generic DAAs to people who need them, much more needs to be done to break through the regulatory red tape that keeps these drugs out of the hands of patients," said co-author Dr. Andrew Hill of the University of Liverpool in the UK. "With enough willpower, this epidemic could be over in 5−10 years. Otherwise, hepatitis C medications could be priced out of reach for all but the extremely rich."

Another report at the conference described research findings of the Path to Zero program, which was developed by The Economist Intelligence Unit (EIU) and commissioned by AbbVie pharmaceuticals. This program compared efforts to combat HCV in 20 countries, from Canada to Croatia and Turkey to Taiwan. Its research framework consists of six key areas that are needed to eliminate HCV: policy; raising awareness, promoting partnerships and creating an enabling environment; surveillance and monitoring; prevention of transmission; testing, access to care and treatment; and capacity-building and research.

protestIndonesian community members advocate for access to Gilead’s drug Sofosbuvir, 2015 

The report concluded that influencing political will is essential to ending the HCV epidemic. Allocation of national health budgets to support hepatitis treatment, more effective negotiations around drug price reductions by governments and health authorities, and engagement with communities at high-risk of hepatitis, such as people who inject drugs, should be priorities in efforts to eliminate hepatitis.