1. World Health Organization
24 November, 2018
Access and affordability – Hepatitis C
Suzanne Hill
IPC, December 2015

2. acknowledgements Sabine Vogler, GOEG Swathi Iyengar Kiu Tay
Peter Beyer

3. World Health Organization
The story so far….
24 November, 2018
New direct acting antivirals on the EML:
Sofosbuvir
simeprevir
daclatasvir
dasbuvir
sofosbuvir/ledipasvir
ombitasvir + paritaprevir + ritonavir
WHO treatment guidelines recommending roll-out

4. Clinical issues
Diagnosis
Genotype of infection

5. WHO Treatment Guidelines 2014

6. Clinical issues Diagnosis Genotype of infection Stage of liver disease
Co morbidities
Supervision of treatment

7. WHO support To Egypt Through PAHO strategic fund
Negotiated price (roughly USD900/course)
Voluntary license arrangements
Through PAHO strategic fund
Negotiated price = Brazil

8. Financial Times

9. Cost of hepatitis C treatments?
Clin Infect Dis. (2014) doi: /cid/ciu012

10. methods
Analysis of price data for sofosbuvir, sof/led from as many countries as possible, with PPI data from Europe
Assume that 23% rebate is base case
Adjust price based on exchange rate and PPP
Estimate total cost of treatment, for various levels of coverage
Estimate proportion of total pharmaceutical expenditure
Estimate cost to patient based on minimum wage

11. note
Manuscript is under review so data are still confidential

12. Price comparison

15. ledipasvir/sofosbuvir
Treatment
coverage
Country
sofosbuvir
ledipasvir/sofosbuvir
10%
50%
75%
100%
Portugal
17.3%
86.5%
129.7%
172.9%
16.5%
82.6%
124.0% %
Poland
16.2%
81.1%
121.6%
162.2%
19.1%
95.3%
142.9% %
New Zealand
15.5%
77.5%
116.3%
155.0%
15.1%
75.6%
113.4% %
Spain
13.0%
64.9%
97.4%
129.9%
11.2%
56.0%
83.9% %
Italy
11.1%
55.6%
83.4%
111.1%
12.3%
61.7%
92.6% %
Greece
9.7%
48.3%
72.4%
96.6% NA
Slovak Republic
9.0%
45.0%
67.4%
89.9%
Switzerland
6.7%
33.7%
50.6%
67.5%
5.6%
28.1%
42.2%
56.3%
Japan
5.2%
26.1%
39.1%
52.1%
6.8%
33.8%
50.7%
67.6%
United States
25.9%
38.8%
51.7%
5.8%
29.1%
43.6%
58.2%
Luxembourg
5.1%
25.5%
38.2%
50.9%
6.4%
32.1%
48.2%
64.3%
Ireland
4.2%
21.2%
31.8%
42.4%
Denmark
3.9%
19.6%
29.4%
39.2%
5.9%
29.3%
43.9%
58.6%
Sweden
3.8%
28.7%
3.2%
15.9%
23.9%
31.9%
Belgium
3.1%
15.6%
23.5%
31.3%
Norway
3.0%
15.2%
22.8%
30.4%
3.4%
16.9%
25.4%
Canada
14.9%
22.4%
29.9%
3.6%
18.2%
27.3%
36.4%
United Kingdom
22.3%
29.7%
3.3%
16.6%
24.8%
33.1%
Finland
2.9%
14.4%
21.6%
28.8%
25.3%
Austria
2.1%
10.7%
16.1%
21.4%
2.4%
12.0%
18.0%
24.0%
Germany
10.5%
15.8%
21.1%
2.6%
13.1%
19.7%
26.3%
France
1.8%
13.4%
17.9%
2.0%
10.0%
20.1%
Netherlands
1.0%
7.9%
1.4%
7.0%
14.0%
KEY
Level of TPE
0-9.9% % %
50-100%
>100%
NA: Medicine is not available

16. Just as an aside…

19. What should WHO do?

20. FROM: Policy Options for pharmaceutical pricing and purchasing: issues for low and middle income countries. Nguyen et al Health Policy and Planning 2015.

22. Time for a change?
External reference pricing problematic in some settings
Concealed rebates and discounts
Unaffordable total cost
No global buyer….
Suggestions?