Junzheng Wang1, Jacob Levi2, Leah Ellis1, Andrew Hill3. 1. Faculty of Medicine, Imperial College London, London, United Kingdom. 2. Department of Intensive Care, University College London Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 3. Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom.
Abstract
BACKGROUND: Currently, only dexamethasone, tocilizumab, and sarilumab have conclusively been shown to reduce mortality of coronavirus disease 2019 (COVID-19). Safe and effective treatments will need to be both affordable and widely available globally to be used alongside vaccination programs. This analysis will estimate and compare potential generic minimum costs of a selection of approved COVID-19 drug candidates with available international list prices. METHODS: We searched for repurposed drugs that have been approved by at least one of the World Health Organization, US Food and Drug Administration, or the United Kingdom National Institute of Health and Care Excellence organizations or at least given emergency use authorization or recommended for off-label prescription. Drug prices were searched for dexamethasone, budesonide, baricitinib, tocilizumab, casirivimab, and imdevimab, and sarilumab, using active pharmaceutical ingredients (APIs) data extracted from global shipping records. This was compared with national pricing data from a range of low-, medium-, and high-income countries. Annual API export volumes from India were used to estimate the current availability of each drug. RESULTS: Repurposed therapies can be generically manufactured for some treatments at very low per-course costs, ranging from US $2.58 for intravenous (IV) dexamethasone (or US $0.19 orally) and US $4.34 for inhaled budesonide. No export price data were available for baricitinib, tocilizumab, casirivimab, and imdevimab, or sarilumab, but courses of these treatments have higher prices, ranging from US $6.67 for baricitinib to US $875.5 for sarilumab. When comparing international list prices, we found wide variations between countries. CONCLUSIONS: Successful management of COVID-19 will require equitable access to treatment for all populations, not just those able to pay high prices. Dexamethasone and budesonide are widely available and affordable, whereas monoclonal antibodies and IV treatment courses are more expensive.
BACKGROUND: Currently, only dexamethasone, tocilizumab, and sarilumab have conclusively been shown to reduce mortality of coronavirus disease 2019 (COVID-19). Safe and effective treatments will need to be both affordable and widely available globally to be used alongside vaccination programs. This analysis will estimate and compare potential generic minimum costs of a selection of approved COVID-19 drug candidates with available international list prices. METHODS: We searched for repurposed drugs that have been approved by at least one of the World Health Organization, US Food and Drug Administration, or the United Kingdom National Institute of Health and Care Excellence organizations or at least given emergency use authorization or recommended for off-label prescription. Drug prices were searched for dexamethasone, budesonide, baricitinib, tocilizumab, casirivimab, and imdevimab, and sarilumab, using active pharmaceutical ingredients (APIs) data extracted from global shipping records. This was compared with national pricing data from a range of low-, medium-, and high-income countries. Annual API export volumes from India were used to estimate the current availability of each drug. RESULTS: Repurposed therapies can be generically manufactured for some treatments at very low per-course costs, ranging from US $2.58 for intravenous (IV) dexamethasone (or US $0.19 orally) and US $4.34 for inhaled budesonide. No export price data were available for baricitinib, tocilizumab, casirivimab, and imdevimab, or sarilumab, but courses of these treatments have higher prices, ranging from US $6.67 for baricitinib to US $875.5 for sarilumab. When comparing international list prices, we found wide variations between countries. CONCLUSIONS: Successful management of COVID-19 will require equitable access to treatment for all populations, not just those able to pay high prices. Dexamethasone and budesonide are widely available and affordable, whereas monoclonal antibodies and IV treatment courses are more expensive.
Authors: Anthony C Gordon; Paul R Mouncey; Farah Al-Beidh; Kathryn M Rowan; Alistair D Nichol; Yaseen M Arabi; Djillali Annane; Abi Beane; Wilma van Bentum-Puijk; Lindsay R Berry; Zahra Bhimani; Marc J M Bonten; Charlotte A Bradbury; Frank M Brunkhorst; Adrian Buzgau; Allen C Cheng; Michelle A Detry; Eamon J Duffy; Lise J Estcourt; Mark Fitzgerald; Herman Goossens; Rashan Haniffa; Alisa M Higgins; Thomas E Hills; Christopher M Horvat; Francois Lamontagne; Patrick R Lawler; Helen L Leavis; Kelsey M Linstrum; Edward Litton; Elizabeth Lorenzi; John C Marshall; Florian B Mayr; Daniel F McAuley; Anna McGlothlin; Shay P McGuinness; Bryan J McVerry; Stephanie K Montgomery; Susan C Morpeth; Srinivas Murthy; Katrina Orr; Rachael L Parke; Jane C Parker; Asad E Patanwala; Ville Pettilä; Emma Rademaker; Marlene S Santos; Christina T Saunders; Christopher W Seymour; Manu Shankar-Hari; Wendy I Sligl; Alexis F Turgeon; Anne M Turner; Frank L van de Veerdonk; Ryan Zarychanski; Cameron Green; Roger J Lewis; Derek C Angus; Colin J McArthur; Scott Berry; Steve A Webb; Lennie P G Derde Journal: N Engl J Med Date: 2021-02-25 Impact factor: 91.245
Authors: Peter Horby; Wei Shen Lim; Jonathan R Emberson; Marion Mafham; Jennifer L Bell; Louise Linsell; Natalie Staplin; Christopher Brightling; Andrew Ustianowski; Einas Elmahi; Benjamin Prudon; Christopher Green; Timothy Felton; David Chadwick; Kanchan Rege; Christopher Fegan; Lucy C Chappell; Saul N Faust; Thomas Jaki; Katie Jeffery; Alan Montgomery; Kathryn Rowan; Edmund Juszczak; J Kenneth Baillie; Richard Haynes; Martin J Landray Journal: N Engl J Med Date: 2020-07-17 Impact factor: 91.245
Authors: Gilmar Reis; Eduardo Augusto Dos Santos Moreira-Silva; Daniela Carla Medeiros Silva; Lehana Thabane; Aline Cruz Milagres; Thiago Santiago Ferreira; Castilho Vitor Quirino Dos Santos; Vitoria Helena de Souza Campos; Ana Maria Ribeiro Nogueira; Ana Paula Figueiredo Guimaraes de Almeida; Eduardo Diniz Callegari; Adhemar Dias de Figueiredo Neto; Leonardo Cançado Monteiro Savassi; Maria Izabel Campos Simplicio; Luciene Barra Ribeiro; Rosemary Oliveira; Ofir Harari; Jamie I Forrest; Hinda Ruton; Sheila Sprague; Paula McKay; Alla V Glushchenko; Craig R Rayner; Eric J Lenze; Angela M Reiersen; Gordon H Guyatt; Edward J Mills Journal: Lancet Glob Health Date: 2021-10-28 Impact factor: 38.927