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Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis

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  • Swathi Iyengar
  • Kiu Tay-Teo
  • Sabine Vogler
  • Peter Beyer
  • Stefan Wiktor
  • Kees de Joncheere
  • Suzanne Hill

Abstract

Introduction: New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients. Methods and Findings: Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries’ annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements. Conclusions: Current prices of these medicines are variable and unaffordable globally. These prices threaten the sustainability of health systems in many countries and prevent large-scale provision of treatment. Stakeholders should implement a fairer pricing framework to deliver lower prices that take account of affordability. Without lower prices, countries are unlikely to be able to increase investment to minimise the burden of hepatitis C. Suzanne Hill and colleagues provide an economic analysis of the prices, costs, and affordability of new hepatitis C medicines in 30 countries.Why Was This Study Done?: What Did the Researchers Do and Find?: What Do These Findings Mean?:

Suggested Citation

  • Swathi Iyengar & Kiu Tay-Teo & Sabine Vogler & Peter Beyer & Stefan Wiktor & Kees de Joncheere & Suzanne Hill, 2016. "Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis," PLOS Medicine, Public Library of Science, vol. 13(5), pages 1-22, May.
  • Handle: RePEc:plo:pmed00:1002032
    DOI: 10.1371/journal.pmed.1002032
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    Cited by:

    1. Rakesh Aggarwal & Qiushi Chen & Amit Goel & Nicole Seguy & Razia Pendse & Turgay Ayer & Jagpreet Chhatwal, 2017. "Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-15, May.
    2. Daniela Moye-Holz & S. Vogler, 2022. "Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 67-77, January.
    3. Salant, Stephen, 2021. "Arbitrage Deterrence: A Theory of International Drug Pricing," RFF Working Paper Series 21-07, Resources for the Future.
    4. Sabine Vogler, 2019. "Fair prices for medicines? Exploring competent authorities’ and public payers’ preferences on pharmaceutical policies," Empirica, Springer;Austrian Institute for Economic Research;Austrian Economic Association, vol. 46(3), pages 443-469, August.
    5. Salas-Vega, Sebastian & Shearer, Emily & Mossialos, Elias, 2020. "Relationship between costs and clinical benefits of new cancer medicines in Australia, France, the UK, and the US," Social Science & Medicine, Elsevier, vol. 258(C).
    6. Magnac, Thierry & Dubois, Pierre, 2023. "Optimal Intertemporal Curative Drug Expenses: The Case of Hepatitis C in France," TSE Working Papers 23-1402, Toulouse School of Economics (TSE).
    7. Jae Ho Jung & Dae Jung Kim & Kangho Suh & Jaeeun You & Je Ho Lee & Kyung In Joung & Dong Churl Suh, 2021. "International Price Comparisons of Anticancer Drugs: A Scheme for Improving Patient Accessibility," IJERPH, MDPI, vol. 18(2), pages 1-14, January.
    8. Aris Angelis & Huseyin Naci & Allan Hackshaw, 2020. "Recalibrating Health Technology Assessment Methods for Cell and Gene Therapies," PharmacoEconomics, Springer, vol. 38(12), pages 1297-1308, December.
    9. Sarah Garner & Andrew Rintoul & Suzanne R. Hill, 2018. "Value-Based Pricing: L’Enfant Terrible?," PharmacoEconomics, Springer, vol. 36(1), pages 5-6, January.
    10. Shu‐Mei Tsai & Jung‐Ta Kao & Yun‐Fang Tsai, 2019. "Illness trajectory of initial infection for patients with hepatitis C: A qualitative study," Nursing & Health Sciences, John Wiley & Sons, vol. 21(1), pages 112-118, March.
    11. Joost W. Geenen & Cornelis Boersma & Olaf H. Klungel & Anke M. Hövels, 2019. "Accuracy of budget impact estimations and impact on patient access: a hepatitis C case study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 857-867, August.
    12. Tomasz Zaprutko & Dorota Kopciuch & Krzysztof Kus & Piotr Merks & Monika Nowicka & Izabela Augustyniak & Elżbieta Nowakowska, 2017. "Affordability of medicines in the European Union," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-13, February.
    13. Roy Lothan & Noa Gutman & Dan Yamin, 2022. "Country versus pharmaceutical company interests for hepatitis C treatment," Health Care Management Science, Springer, vol. 25(4), pages 725-749, December.
    14. Jalal Dahham & Ingrid Kremer & Mickaël Hiligsmann & Kamal Hamdan & Abdallah Nassereddine & Silvia M. A. A. Evers & Rana Rizk, 2023. "Valuation of Costs in Health Economics During Financial and Economic Crises: A Case Study from Lebanon," Applied Health Economics and Health Policy, Springer, vol. 21(1), pages 31-38, January.
    15. Lauren E. Cipriano & Shan Liu & Kaspar S. Shahzada & Mark Holodniy & Jeremy D. Goldhaber-Fiebert, 2018. "Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes," Medical Decision Making, , vol. 38(7), pages 849-865, October.
    16. David Beheshti, 2019. "Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin," Health Economics, John Wiley & Sons, Ltd., vol. 28(12), pages 1449-1461, December.
    17. Roediger, Alexander & Wilsdon, Tim & Haderi, Artes & Pendleton, Kathy & Azais, Boris, 2019. "Competition between on-patent medicines in Europe," Health Policy, Elsevier, vol. 123(7), pages 652-660.
    18. Chunming Xu & Debao Zhu, 2021. "On Conflicts between Pharmaceutical Patent Protection and the Right to Life and Health Based on a Stackelberg Game," IJERPH, MDPI, vol. 18(3), pages 1-13, January.

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