Pharma companies pledge to lower the cost of hepatitis treatment

Two pharmaceutical companies have agreed to dramatically reduce the cost of viral hepatitis treatments.

Viatris and Hetero, who both manufacture hepatitis treatments, have pledged to reduce the price of both hepatitis C (HCV) and hepatitis B (HBV) treatments to enable more people to access the life-saving medication.

Sofobuvir and daclatasvir, a 12-week once daily oral treatment for HCV, will now be offered at a ceiling price of US$60 per patient course of treatment.

Tenofovir disoproxil fumarate (TDF), a once-daily tablet which is taken for life for HBV, will now be sold at a ceiling price of US$2.4 per 30 tablets, which is less than $29 per year.

The vice presidents of the companies, Kedar Madhekar (Viatris) and Rahul Lande (Hetero), made the announcement at the Global Hepatitis Resource Mobilization Conference in Geneva (17 May).

The conference was hosted by the Arab Republic of Egypt and the Kingdom of Saudi Arabia, two countries with high burdens of hepatitis. Chelsea Clinton, Vice Chair of the board of directors for the Clinton Health Access Initiative (CHAI) and World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus addressed the event, which was also attended by a number of health ministers, key global funders, and civil society representatives.

Hepatitis will kill more people than HIV, TB and malaria combined by 2040

These new commitments have been made as part of a reinvigorated effort to eradicate hepatitis by 2030, in line with the WHO’s target.

Hepatitis is predicted to kill more people than HIV, tuberculosis and malaria combined by 2040. Fortunately, however, the tools to prevent, test and treat viral hepatitis already exist.

According to the WHO, investing US$6 billion annually to end hepatitis in 67 low- and middle-income countries would prevent the deaths of 4.5 million people by 2030.

Preventing and treating hepatitis B

Around 300 million individuals are estimated to be living with HBV, and the complications of the virus (such as liver disease) are estimated to kill just under one million people annually.

HBV is predominantly spread through vertical transmission – the passing of disease from mother to infant immediately before or after birth.

Thankfully, an inexpensive, safe and effective HBV vaccine already exists, and in the UK, every new born baby is given a dose. However, in low- and middle-income countries, many babies do not receive this lifesaving vaccine, leaving them exposed to infection.

While global coverage of timely HBV-BD (birth dose) is as high as 78% in the WHO Western Pacific Region, it is estimated to be just 17% in the WHO African region.

While vaccine rates are still poor in low- and middle-income countries, access to care and treatment needs to be accessible and affordable, but up until now, the cost of TDF was up to 12 times higher in poorer regions than the benchmark price of US$32 negotiated by The Global Fund to Fight AIDS, Tuberculosis and Malaria for HIV programmes.

With HBV treatment often unaffordable in poorer nations, their health systems are likely to experience greater pressure, as more people seek treatment for cirrhosis, liver cancer and other linked illnesses. Treating such diseases is costly and studies have shown that implementing hepatitis elimination programmes results in greater cost savings for countries with a high burden of the disease.

In fact, research has shown that for every dollar spent on HBV elimination efforts, there is a two to four times return on investment. For example, investments in HBV elimination are estimated to enable cost savings in the Philippines by 2024 and in Vietnam by 2027.

Diagnosing and treating hepatitis C

There are currently 58 million people living with HCV, and 290,000 die yearly from HCV-related liver complications such as cirrhosis and liver cancer.

It is a blood-borne virus spread through blood-to-blood contact (such as unscreened blood transfusions and unsafe injections). Unsafe injection drug use contributes to over 40% of new infections, and 25% of incarcerated people have an active hepatitis C infection (which could be due to practices such as unsafe tattooing).

While there is no vaccine for hepatitis C, direct-acting antivirals (DAACs) can now cure more than 95% of patients within just 12 weeks. Raquel Peck, who has now been cured of HCV, underwent treatment for HCV before DAACs had been developed.

Speaking at the conference, Peck talked about how life changing DAACs have been for her. She said: “The injections had horrible side effects and there was less than a 50% chance that I would be cured … I had a year of horror, absolute horror … and just a few weeks after I finished treatment, the virus was back. It didn’t work.”

“I did eventually get my cure with [the new antivirals]. The new drugs were easy peasy, no side effects and I can’t describe the feeling of the weight that comes off your shoulders when you’re cured.”

However, only 21% of people with chronic HCV are aware of their status, and only 13% of diagnosed people have received treatment. According to the WHO, elimination can be achieved by diagnosing 90% of people living with HCV and treating 80% of those who are diagnosed.

HCV elimination would avert a further 2.1 million deaths globally, generating $46.1 billion in cumulative productivity gains. This means, HCV elimination efforts would become cost-saving by 2027, and by 2030, there would be a net economic benefit of $22.7 billion. And now, with treatment for HVC capped at $60 for one course of treatment, eliminating hepatitis C is even more affordable and accessible.

Eliminating hepatitis is achievable with the political will and commitment from governments

Speaking at the conference, Michel Kazatchkine, former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said: “Viral hepatitis is no more a hidden pandemic. It is understood and accepted as a major global public health infectious challenge.

“Ending hepatitis is not just an aspiration. It is achievable. The rollout of antiretroviral drugs has shown us that what was considered utopia has become an achievable global target.”

Mr Kazatchkine highlighted that several low- and middle- income countries, including Egypt, Rwanda, Georgia and Mongolia, are on the road to eliminating viral hepatitis, and others, such as Cambodia, India, Indonesia and Nigeria, have implemented elimination programmes.

“Despite the setbacks we have seen across global health over the past three years, national, regional and global efforts are accelerating, but this effort will only succeed when backed by local commitment and local resources.

“One of the important lessons from the fight against AIDS, tuberculosis and malaria, is that international financial support has a positive effect far beyond the money provided: it focuses minds and priorities; it sends a strong signal of solidarity; it channels resources to those otherwise neglected and marginalized; and it sets an expectation – and provides a framework for – results and impact,” he said.