Minimum manufacturing costs, national prices and estimated global availability of new repurposed therapies for COVID-19

DOI record: { "DOI": "10.1101/2021.06.01.21258147", "URL": "http://dx.doi.org/10.1101/2021.06.01.21258147", "abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Currently, only dexamethasone, tocilizumab and sarilumab have conclusively been shown to reduce mortality of COVID-19. Safe and effective treatments will need to be both affordable and widely available globally to be used alongside vaccination programmes. This analysis will estimate and compare potential generic minimum costs of a selection of approved COVID-19 drug candidates with available international list prices.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We searched for repurposed drugs that have been approved by at least one of the WHO, FDA or NICE, or at least given emergency use authorisation or recommended for off-label prescription. Drug prices were searched for, for dexamethasone, budesonide, baricitinib, tocilizumab, casirivimab and imdevimab, and sarilumab using active pharmaceutical ingredients (API) 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Repurposed therapies can be generically manufactured for some treatments at very low per-course costs, ranging from $2.58 for IV dexamethasone (or $0.19 orally) and $4.34 for inhaled budesonide. No export price data was available for baricitinib, tocilizumab, casirivimab and imdevimab or sarilumab, but courses of these treatments are priced highly, ranging from $6.67 for baricitinib to $875.5 for sarilumab. When comparing international list prices, we found wide variations between countries.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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, whilst monoclonal antibodies and IV treatment courses are more expensive.</jats:p></jats:sec><jats:sec><jats:title>Key Points</jats:title><jats:list list-type=\"bullet\"><jats:list-item><jats:p>Re-purposed drugs must be affordable worldwide to compliment COVID-19 vaccine programmes.</jats:p></jats:list-item><jats:list-item><jats:p>Estimated costs/course were: dexamethasone (Oral $0.22, IV $2.58), budesonide ($4.34), baricitnib ($6.67), tocilizumab ($410.59), sarilumab ($875.70). Casirivimab and imdevimab = no data available.</jats:p></jats:list-item><jats:list-item><jats:p>High drug prices will limit access.</jats:p></jats:list-item></jats:list></jats:sec>", "accepted": { "date-parts": [ [ 2021, 10, 18 ] ] }, "author": [ { "ORCID": "http://orcid.org/0000-0002-7635-9461", "affiliation": [], "authenticated-orcid": false, "family": "Wang", "given": "Junzheng", "sequence": "first" }, { "affiliation": [], "family": "Levi", "given": "Jacob", "sequence": "additional" }, { "affiliation": [], "family": "Ellis", "given": "Leah", "sequence": "additional" }, { "affiliation": [], "family": "Hill", "given": "Andrew", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2021, 6, 4 ] ], "date-time": "2021-06-04T03:25:14Z", "timestamp": 1622777114000 }, "deposited": { "date-parts": [ [ 2022, 12, 29 ] ], "date-time": "2022-12-29T19:26:22Z", "timestamp": 1672341982000 }, "group-title": "Health Economics", "indexed": { "date-parts": [ [ 2024, 3, 1 ] ], "date-time": "2024-03-01T23:52:47Z", "timestamp": 1709337167721 }, "institution": [ { "name": "medRxiv" } ], "is-referenced-by-count": 2, "issued": { "date-parts": [ [ 2021, 6, 3 ] ] }, "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1101/2021.06.01.21258147", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "246", "original-title": [], "posted": { "date-parts": [ [ 2021, 6, 3 ] ] }, "prefix": "10.1101", "published": { "date-parts": [ [ 2021, 6, 3 ] ] }, "publisher": "Cold Spring Harbor Laboratory", "reference": [ { "DOI": "10.1136/bmj.n292", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.1" }, { "DOI": "10.1016/S2055-6640(20)30018-2", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.2" }, { "DOI": "10.1056/NEJMoa2022926", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.3" }, { "DOI": "10.1056/NEJMoa2023184", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.4" }, { "DOI": "10.1016/S0140-6736(20)32013-4", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.5" }, { "DOI": "10.1016/S0140-6736(21)00149-5", "doi-asserted-by": "publisher", "key": "2021102011301112000_2021.06.01.21258147v3.6" }, { "DOI": "10.1101/2021.05.18.21257267", "doi-asserted-by": "crossref", "key": "2021102011301112000_2021.06.01.21258147v3.7", "unstructured": "RECOVERY Collaborative Group. 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