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

{ 'institution': [{'name': 'medRxiv'}], 'indexed': {'date-parts': [[2024, 3, 1]], 'date-time': '2024-03-01T23:52:47Z', 'timestamp': 1709337167721}, 'posted': {'date-parts': [[2021, 6, 3]]}, 'group-title': 'Health Economics', 'reference-count': 49, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2021, 10, 18]]}, '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>', 'DOI': '10.1101/2021.06.01.21258147', 'type': 'posted-content', 'created': {'date-parts': [[2021, 6, 4]], 'date-time': '2021-06-04T03:25:14Z', 'timestamp': 1622777114000}, 'source': 'Crossref', 'is-referenced-by-count': 2, 'title': 'Minimum manufacturing costs, national prices and estimated global availability of new repurposed ' 'therapies for COVID-19', 'prefix': '10.1101', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-7635-9461', 'authenticated-orcid': False, 'given': 'Junzheng', 'family': 'Wang', 'sequence': 'first', 'affiliation': []}, {'given': 'Jacob', 'family': 'Levi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Leah', 'family': 'Ellis', 'sequence': 'additional', 'affiliation': []}, {'given': 'Andrew', 'family': 'Hill', 'sequence': 'additional', 'affiliation': []}], 'member': '246', 'reference': [ { 'key': '2021102011301112000_2021.06.01.21258147v3.1', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmj.n292'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.2', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2055-6640(20)30018-2'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.3', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2022926'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.4', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2023184'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.5', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(20)32013-4'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.6', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(21)00149-5'}, { 'key': '2021102011301112000_2021.06.01.21258147v3.7', 'doi-asserted-by': 'crossref', 'unstructured': 'RECOVERY Collaborative Group. 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