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

摘要: Introduction New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices limited access, prompting wide debate about fair affordable prices. This study systematically compared the price affordability of sofosbuvir ledipasvir/sofosbuvir across 30 countries to assess health systems patients. Methods Findings Published 2015 ex-factory for a 12-wk course were provided by Pharma Price Information (PPI) service Austrian public institute Gesundheit Osterreich GmbH or obtained from national government drug reimbursement authorities recent press releases, where necessary. Prices in Organisation Economic Co-operation Development (OECD) member select low- middle-income converted US dollars using period average exchange rates adjusted purchasing power parity (PPP). We analysed economic performance estimated market size cost these drugs terms countries’ annual total pharmaceutical expenditure (TPE) duration time an individual would need work pay out pocket. Patient was calculated 2014 OECD wages, supplemented with International Labour Organization median wage data All compiled between 17 July 25 January 2016. For base case analysis, we assumed 23% rebate/discount on published all countries, except special pricing arrangements generic licensing agreements. The nominal 26 US$42,017, ranging US$37,729 Japan US$64,680 US. Central Eastern European had higher PPP-adjusted than other countries: Poland Turkey (PPP$101,063 PPP$70,331) (PPP$118,754) at least 1.09 1.63 times higher, respectively (PPP$64,680 PPP$72,765). Based TPE without ribavirin costs, treating entire HCV viraemic population regimens reduction amount one-tenth current included this study, 10.5% Netherlands 190.5% Poland. In 12 costs equivalent 1 y more individuals, 0.21 Egypt 5.28 Turkey. analysis relies accuracy information infection prevalence estimates. It does not include diagnostic testing, supplementary treatments, patients reinfection cirrhosis, associated costs. Conclusions Current are variable unaffordable globally. These threaten sustainability many prevent large-scale provision treatment. Stakeholders should implement fairer framework deliver lower that take account affordability. Without prices, unlikely be able increase investment minimise burden C.