Hepatitis treatment

Published July 28, 2015

HEPATITIS C is a major global killer. Worldwide, the disease affects between 150 to 185 million people. Hepatitis C-related deaths number between 350,000 and 500,000 annually. A guesstimate for Pakistan suggests 10-15 million affected, with 28,000 cases added to this number every year. Yet its treatment is prohibitively expensive, with the injection-based interferon treatment costing about $18,000 for a 48-week course in the US, thus pricing out patients in low- and middle-income countries.

Nevertheless, some countries such as Egypt, where 10-14pc of the population is infected with hepatitis C, have managed to secure a deal for the country’s patients with multinational pharmaceuticals. As a result, the cost of treatment went down to about $2,000 and benefitted 220,000 patients, according to an article on the Open Society Foundations website. Thailand has gone a step further by bringing the treatment of hepatitis C within the ambit of universal health coverage.

Pakistan, on the other hand, despite having a huge population of hepatitis C sufferers, has not paid sufficient attention to the challenge. However, it appears there has been a belated outbreak of good sense from government quarters on this front recently. This has coincided with advances in the treatment of hepatitis C with new orally-based direct-acting medicine coming into the market.

Since 2013, Gilead Science, a US pharmaceutical giant, has led the effort by producing a new line of oral drugs with far fewer side effects than those associated with the previously injection-based interferon treatment. The treatment is slowly spreading beyond its US base where it is still exorbitantly priced between $63,000 and $84,000. Like interferon, the cost of the new treatment is again beyond the capacity of patients in the low- and middle-income countries. However, Gilead has entered into agreement with 11 generic drug makers around the world to provide the new treatment at a lower cost in 91 countries.

The lethargic Drugs Regulatory Authority of Pakistan (DRAP) has at last woken up to the growing hepatitis C crisis by giving the go-ahead to the new drug under the brand name of Sovaldi produced by Gilead. The medicine is being marketed by a local pharmaceutical company reportedly at Rs32,000 for one month’s treatment. Although still not cheap by most standards, the price is nevertheless being touted as a big pro-patient concession, having been reduced by 40pc from the originally determined price of Rs55,000 for one month’s treatment.


The new treatment for hepatitis C must be made cheap & easily available.


In order to drive the point home, parallels are being drawn with Egypt where the new drug is reported to be available at a much higher price. The reality, however, is quite different. Egypt furnishes an example of a success story where the government has negotiated a good deal with multinational pharma­­­ceutical companies to provide drugs at reduced prices to hepatitis C sufferers. Further, the Egyptian government has subsidised the treatment on a systematic basis. As in the case of interferon treatment, the Egyptian government has negotiated a long-term deal with Gilead to provide the new oral treatment at a reduced cost ranging from $900-1,900 for four to 12 weeks’ treatment which is far cheaper than in Pakistan. In addition, unlike Pakistan, the Egyptian government has set up a health exchange where hepatitis patients can register for treatment at further subsidised rates. The online registration system has already attracted huge numbers.

In contrast, DRAP has granted sole monopoly to market Gilead’s new line of oral drugs to one local company. The price charged is higher with the result that most patients are priced out. Moreover, the new drugs are available only through a slow, cumbersome and restrictive registration process. As a result, the number of patients who have so far benefitted from the new treatment only runs into a few thousand. In addition, the market exclusivity keeps the price artificially high, further restricting access to the medicine. This has become especially significant since another local pharmaceutical company has undertaken to provide the new medicine at a much reduced price of Rs11,000 per month.

Therefore if the government wants to make good on its promise of providing cheap and prompt treatment to hepatitis sufferers, it must change its current strategy. It must open up the market to more companies by granting them licences for generic production of the new drugs. For this to happen, however, the generic producers need to make sure that the generics produced are of the same quality as the original. Lastly, if there is one global lesson from the hepatitis control programme, it is that where governments committed to public health have acted decisively, they have managed to obtain deals from multinational drug companies that are advantageous to patients rather than give sole monopoly to private companies to market the new treatments as is the case in Pakistan.

The writer is a development consultant and policy analyst.

drarifazad@gmail.com

Twitter @arifazad5

Published in Dawn, July 28th, 2015

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