Minimum manufacturing costs, national prices and estimated global availability of new repurposed therapies for COVID-19
Junzheng Wang, Jacob Levi, Leah Ellis, Dr Andrew Hill
doi:10.1101/2021.06.01.21258147
Background 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.
Methods: 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. Results: Repurposed therapies can be generically manufactured for some treatments at
Conflicts of interest: None to declare.
References
Ahlqvist, Mcgeough, Senanayake, Armstrong, Yadaw et al., Progress Toward a Large-Scale Synthesis of Molnupiravir (MK-4482, EIDD-2801) from Cytidine, ACS Omega,
doi:10.1021/acsomega.1c00772Barber, Dzintars, Estimated cost-based generic prices for molnupiravir for the treatment of COVID-19 infection
Bhuyan, In India, black markets for tocilizumab spring up as demand for the Covid-19 drug surges
Eaton, Covid-19: WHO warns against "vaccine nationalism" or face further virus mutations, BMJ,
doi:10.1136/bmj.n292Gotham, Barber, Hill, Estimation of cost-based prices for injectable medicines in the WHO Essential Medicines List, BMJ Open
Group, Yu, Bafadhel, Dorward, Hayward et al., Inhaled budesonide for COVID-19 in people at higher risk of adverse outcomes in the community: interim analyses from the PRINCIPLE trial,
doi:10.1101/2021.04.10.21254672Hill, Barber, Gotham, Estimated costs of production and potential prices for the WHO Essential Medicines List, BMJ Global Health
Hill, Garratt, Levi, Falconer, Ellis et al., Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection
Hill, Simmons, Gotham, Rapid reductions in prices for generic sofosbuvir and daclatasvir to treat hepatitis C, J Virus Erad
Hill, Wang, Levi, Minimum costs to manufacture new treatments for COVID-19
Horby, Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, Lancet,
doi:10.1016/S0140-6736(21)00149-5Horby, Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label
Horby, Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label
Horby, Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, Lancet,
doi:10.1016/S0140-6736(20)32013-4Investigators, Gordon, Mouncey, Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19, N Engl J Med,
doi:10.1056/NEJMoa2100433Kalil, Patterson, Mehta, Baricitinib plus remdesivir for hospitalized adults with Covid-19, New England Journal of Medicine
Khan, Stewart, Fabbri, Systematic review and meta-analysis of anakinra, sarilumab, siltuximab and tocilizumab for COVID-19, Thorax. Published Online First,
doi:10.1136/thoraxjnl-2020-215266Klutz, Holtmann, Lobedann, Cost evaluation of antibody production processes in different operation modes, Chemical Engineering Science
Love, The production of generic drugs in India, BMJ
Mahase, Covid-19: Molnupiravir reduces risk of hospital admission or death by 50% in patients at risk, MSD reports, BMJ
Moon, Jambert, Childs, A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries, Global Health,
doi:10.1186/1744-8603-7-39New, Revise Biosimilar Guidelines, Scientists Demand; WHO Says Not Now
Popp, Stegemann, Metzendorf, Gould, Kranke et al., Ivermectin for preventing and treating COVID-19, Cochrane Database of Systematic Reviews,
doi:10.1002/14651858.CD015017.pub2Ramakrishnan, Jr, Langford, Mahdi, Jeffers et al., Inhaled in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial, Lancet Respiratory Medicine
Recovery Collaborative, Dexamethasone in hospitalized patients with Covid-19, New England Journal of Medicine
Tardif, Bouabdallaoui, Allier, randomised, double-blinded, adaptive, placebocontrolled, multicentre trial
Weinreich, Sivapalasingam, Norton, Ali, Gao et al., REGEN-COV antibody cocktail clinical outcomes study in Covid-19 outpatients
Wire, Governments Spent at Least €93bn on COVID-19 Vaccines and Therapeutics During the Last 11 Months
