Thursday, November 06, 2014

Profits or Cures?

 Hepatitis C is a viral infection that can lurk undiagnosed and transmissible for decades until it causes liver diseases such as cirrhosis and cancer. 180 million people worldwide infected with hep-C, including 3 million to 5 million Americans (many times the 1.1 million Americans living with HIV), we are talking a huge epidemic and a large, desperate market. Most Americans caught the bloodborne virus from injection drug use or, before 1992, through unscreened transfusions or poor needle hygienein clinical settings. Hep-C can also be transmitted through high-risk sex or simply by sharing a razor blade, toothbrush, nail clipper or rolled-up $20 bill passed around to snort cocaine. About half of infected people have never been tested and, until they develop symptoms, will not know they carry—and can pass on—the virus. Without treatment, they risk slow death and high medical billsUp to half a million people around the world die of hep-C each year. Sovaldi could save most of them—if they could afford it.

A new drug, Sovaldi, reportedly cures up to 90 percent of people with hepatitis C,. Unlike take-forever medication like those for high cholesterol, Sovaldi (sofosbuvir) “represents a finite cure, an important point to consider when comparing the price of a pill or bottle to the lifetime costs of treating a chronic disease,” Gilead Sciences Inc., spokesperson Cara Miller said. Gilead also describes Sovaldi as a bargain compared to a half-million-dollar liver transplant.

Considering that point, Gilead set the price at an astounding $1,000 for each daily pill—a total of $84,000 for the minimum 12-week course. That sum would buy a Maserati SQ4 (with $10K in change) or a double-wide mobile home, or feed a thrifty family of four for 11 years. Supplementary drugs can boost the 12-week price to near $100,000. And, depending on the hep-C genotype, some patients—possibly 12 percent in the U.S. and the majority in some heavily infected, poorer countries—need 24 or 48 weeks of daily treatment. Pharmaceutical companies  cite past research and development costs to justify high prices. But Gilead spends only 19 percent of its revenue on research, and in any case, sofosbuvir was developed by Pharmasset Inc. at Emory University as “the result of federally funded university-based research,” according to Science Coalition, a non-profit university research group. The drug was nearly market-ready in November 2011 when Gilead paid $11 billion cash to acquire Pharmassett, which had forecast a $36,000 price tag for the 12-week course. In December 2013, Sovaldi hit the market at well over twice that price. Manufacturing costs for a 12-week course estimated at less than $136.

Affordability is even more problematic for the world’s 40 low-income countries, where average daily incomes range from $1.09 to $2.82 and annual healthcare spending averages $30 per capita, compared to more than $8,000 in America. In the world’s 100 or so middle-income countries, including China and Brazil, average income spans $2.82 to $34.18 a day, and average annual per capita healthcare spending is about $250. Even if curing hep-C patients and stopping the epidemic were a priority, the price is absurdly prohibitive. Gilead can steeply discount Solvadi in low-income countries and still turn a large profit. In India, where 12 million people have hep-C, Gilead charges about 1 percent of the U.S. price—or $900 for the 12-week course. Gilead is also striking discount deals with some middle-income countries—a giant market that has two-thirds of the world’s population, 75 percent of its poor, and the majority of its disease burden. In Egypt, where 10 to 13 percent of the population is infected (the world’s highest prevalence), even with a 99 percent discount, providing a 12-week course to all infected Egyptians would cost 2.5 times the country’s yearly total health spending, based on calculations by the humanitarian NGO Médecins du Monde.

 Gilead is on track to reap more than $10 billion in 2014 sales, virtually guaranteeing it will quickly recoup its investment. Meanwhile, Gilead avoided hundreds of millions of dollars in U.S. taxes by transferring its patent for Sovaldi to its Irish subsidiary.

Taken from here 


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