Abstract: medRxiv preprint doi: https://doi.org/10.1101/2021.06.01.21258147; this version posted October 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Minimum manufacturing costs, national prices and estimated global availability of new repurposed therapies for COVID-19. Authors: Junzheng Wang*1, Jacob Levi*2, Leah Ellis1, Andrew Hill3 Affiliations: 1. Faculty of Medicine, Imperial College London 2. Department of Intensive Care, University College London Hospital, University College London Hospitals NHS Foundation Trust 3. Department of Pharmacology and Therapeutics, University of Liverpool * JW and JL contributed equally to this manuscript. Corresponding author: Dr Andrew Hill PhD Department of Pharmacology and Therapeutics University of Liverpool, 70 Pembroke Place Liverpool L69 3GF, UK Email: microhaart@aol.com Word Count: Abstract – 244; main body – 3498 Key Points (40) • Re-purposed drugs must be affordable worldwide to compliment COVID-19 vaccine programmes. • 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. • High drug prices will limit access. Key Words COVID-19, drug repurposing, drug prices, drug availability, access to medicines NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 1 medRxiv preprint doi: https://doi.org/10.1101/2021.06.01.21258147; this version posted October 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Abstract 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 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..