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Widespread access to new HCV antivirals feasible within 15 years

Large-scale manufacturing of direct-acting antivirals for hepatitis C is possible within the next 15 years, with a minimum target price of $100 to $250 for a 12-week treatment course, recent data suggest.

At that cost, widespread access to such treatments in low- and middle-income countries is a feasible goal, according to the research team from Liverpool University in the United Kingdom, Howard University in Washington, D.C., Imperial College London and University of Cape Town in South Africa.

“Currently, a large proportion of untreated patients continue to spread the HCV pandemic worldwide,” the researchers wrote in Clinical Infectious Diseases. “Lessons learnt from HIV suggest that with the introduction of strong community programs for testing, and high rates of treatment coverage and retention, expanded access to treatment is also likely to have a pronounced effect on HCV transmission, a benefit already suggested in modeling studies.”

The researchers conducted an analysis to estimate the minimum cost of HCV treatment. They assumed the same dynamic seen with HIV treatment and analyzed the potential costs of ribavirin, daclatasvir (Bristol-Myers Squibb), sofosbuvir (Sovaldi, Gilead Sciences) faldaprevir (Boehringer Ingelheim) and simeprevir (Olysio, Janssen Therapeutics). They determined the most comparable HIV drug to each HCV drug to make their estimates.

For ribavirin, the estimated cost was based upon current cost of ribavirin and the cost of the HIV drug zidovudine. A 12-week course of ribavirin was estimated to be $34 to $58, depending on the dose. Daclatasvir was comparable to atazanavir (Reyataz, Bristol-Myers Squibb), and a 12-week course of treatment was estimated to cost $10 to $30. Sofosbuvir, which was compared with stavudine and tenofovir (Viread, Gilead Sciences), cost $68 to $136 for a 12-week treatment course.

Faldaprevir was assumed comparable to darunavir (Prezista, Janssen Therapeutics) and estimated to cost $100 to $210 for 12 weeks of treatment. Lastly, simeprevir, which was comparable to lopinavir-ritonavir (Kaletra, AbbVie), was estimated to cost $130 to $270 for 12 weeks.

“The high cost of drugs is often justified by the need to recover costs of research and development,” the researchers wrote. “Commitments by national governments to scale up antiretroviral therapy, with support from international donors, were critical to leveraging prices by increasing the size and predictability of the HIV market. This will be an essential factor in lowering drug prices and increasing access to HCV [direct-acting antivirals].”

Disclosure: One researcher has consulted for Janssen.