A recent economic study analyzed the high prices of new hepatitis C virus (HCV) medicines, prompting a wide debate about fairness and affordability. The study systematically compared prices of sofosbuvir and ledipasvir/sofosbuvir in 30 countries, including the U.S., to evaluate their affordability to health systems and patients.

The study, “Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis,” was recently published in the journal PLOS Medicine.

The researchers started their analysis by collecting 2015’s prices for a 12-week course of treatment with sofosbuvir monotherapy and ledipasvir/sofosbuvir combined therapy, for as many countries as they could obtain information.

To collect relevant information, the team used sources like Pharma Price – an information service of the Austrian public health institute Gesundheit Österreich GmbH – national government and drug reimbursement authority websites, and press release announcements.

The team then estimated how many patients in each country were infected with HCV based on existing studies, and compared medication prices, adjusting currencies and potential confidential price discounts that might be negotiated by purchasers in each country, as well as the countries’ gross domestic product (GDP).

Based on the data gathered, researchers calculated the likely total cost to each country for treating all their HCV patients, comparing it afterward with the annual total expenditure on medicines for each country. In addition, the study included calculations like the length of time a person needs to work in each country to pay for their treatment, based on the country’s average wages.

The analysis revealed that:

• If patients had to pay for the treatment themselves, the total cost of a full treatment of sofosbuvir alone would equal an entire year’s worth (or more) of average earnings; this is true for the average individual in 12 of the 30 countries analysed.
• The overall total cost of treating all HCV patients would equal at least 10 percent of the current annual cost for all medical expenses in all of the countries studied. In certain countries where the cost of the disease is higher, it would be more expensive to treat all infected patients than the cost of all other medicines combined.
• Prices for HCV medicines contrast considerably across countries – particularly when attuned for national wealth – and less wealthy countries pay higher adjusted prices than wealthier countries.

The findings suggested that the potential cost of treatments poses a financial and ethical dilemma for our society. Sofosbuvir and ledipasvir/sofosbuvir treatments would require national health systems to consume large sections of their total pharmaceutical budget on just one health condition. This has led some countries to restrict access to such medicines to small groups of patients, even though most HCV patients would benefit from this treatment.

If countries do want to treat all HCV-infected patients, governments and industries will need to develop and implement fairer pricing frameworks that allow for more affordable solutions. Without this joint effort, countries might not be able to eradicate this disease.

The authors also caution that their analysis was limited by the accuracy of the information available, which might lead to some inaccurate data, mostly related to confidential agreements between manufacturers and buyers. The estimates of the number of HCV-infected people are also an approximation, as well as the costs of the medication. The study did not include the costs of other parts of HCV treatment.