7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

TULBPE16 - Poster Exhibition


What is the minimum cost per person to cure HCV?

A. Hill1, S. Khoo1, B. Simmons2, N. Ford3

1Liverpool University, Pharmacology and Therapeutics, Liverpool, United Kingdom, 2MetaVirology Ltd, London, United Kingdom, 3University of Cape Town, Infectious Diseases, Cape Town, South Africa

Background: Several combinations of ribavirin plus two Direct Acting Antivirals (DAAs) can cure HCV (sustained virological response) in over 80% of treatment-naïve Genotype-1 patients. DAAs for HCV infection have similar mechanisms of action and chemical structures to antiretrovirals for HIV infection. Generic antiretrovirals are currently manufactured at very low cost, for treatment of over seven million people with HIV in low and middle-income countries.
Methods: Four next generation HCV DAAs, currently in Phase 3 development (daclatasvir, sofosbuvir, simeprevir, faldaprevir) were classified by chemical structure, molecular weight, daily dose, complexity of synthesis and patent expiry dates. The lowest manufacturing costs per gram of HIV antiretrovirals were calculated by treatment class, using Clinton Foundation/MSF published prices for low-income countries. The minimum cost of 12 weeks of treatment with each DAA was then calculated, assuming a production cost per gram of HCV DAA between 1-10 times the equivalent HIV antiretroviral (to control for potential differences in complexity of chemical synthesis).
Results: Minimum manufacturing costs of HIV antiretrovirals were $1.0-$2.1/g for protease inhibitors, $0.2-1.0/g for nucleoside analogues, $0.5/g for nucleotide analogues and $0.2/g for non-nucleosides. The complexity of chemical synthesis for HCV DAAs was ranked from lowest to highest: ribavirin, daclatasvir, sofosbuvir, faldaprevir and simeprevir. The predicted costs for a 12-week course of each DAA, assuming generic manufacture, are shown below:


HCV DAAPatent expiryClass/daily doseTotal dose (12 w)Predicted cost ($)
ribaviringenericNRTI/1200mg84g$20-63
daclatasvir2027NS5a/60mg5g$10-$30
sofosbuvir2029NtRTI/400mg34g$68-$136
faldaprevir2029PI/120mg10g$100-$210
simeprevir2026PI/150mg13g$130-$270
[Predicted minimum cost per person of HCV DAAs]


Conclusions: Within the next 15 years, large-scale manufacture of ribavirin plus two generic HCV DAAs is feasible, with target prices of $100-$200 per 12 week treatment course (for Genotype 1 HCV infection). Further cost reductions may be possible through optimisation of chemical synthesis and cheaper sourcing of raw materials. These low prices could make widespread access to HCV treatment in low and middle-income countries, and potentially even HCV eradication, a realistic goal.

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