全球病毒性肝炎，艾滋病毒和结核病治疗需要新的$ 90- $ 90- $

StephenW

New $90-$90-$90 target needed for global viral hepatitis, HIV and TB treatment
        Andrew Hill speaking at HIV Glasgow. Image credit: HIV Drug Therapy Glasgow 2016

           Keith Alcorn
    Published: 24 October 2016   



           The costs of making drugs to treat viral hepatitis, HIV andtuberculosis (TB) are now so low that each disease could be treated for less than $90, DrAndrew Hill of St Stephen’s AIDS Trust told the opening plenary of theInternational Congress on Drug Therapy in HIV Infection (HIV Glasgow) on Sunday in Glasgow.
The cost of generic drugs to cure TB is already below $90for a six-month treatment course, and some antiretroviral regimens for HIVtreatment have already fallen below $90 a year in lower-income countries. Thecost of generic treatment for hepatitis B and C is also falling, Dr Hill said,with potential for further reductions.
By the end of 2017 it should be possible to treat HIV forthe same price in South Africa and in Europe, but hepatitis C treatment willremain very expensive in higher-income markets, Dr Hill explained, unlesspharmaceutical companies agree to lower the prices of direct-acting antiviralsin return for agreements on treating larger numbers of patients,as inAustralia.
A collapse in the cost of raw materials to manufacture thehepatitis C direct-acting antivirals sofosbuvir and daclatasvir due toeconomies of scale has driven down the feasible price of profitable manufactureof a 12-week course of treatment to $76 and of sofosbuvir/ledipasvir to $96, DrHill told the conference.
Sofosbuvir alone is currently sold by Gilead Sciences for 50,426euros in Germany, the highest-priced market outside the United States.
Hill’s research group is able to project the lowest-possiblemanufacturing cost by analysing trends in costs of shipments of activepharmaceutical ingredients (API), the raw material of drug manufacture, in and out ofIndia. By calculating the amount of API needed to make a course of treatment,adding $0.04 per tablet for excipients and tableting and $0.35 for the cost offormulation, and then adding a 10-50% profit margin, the researchers cancalculate the minimum price a generic manufacturer could make a drug for.
The price of sofosbuvir API has fallen from around $9000per kg in January 2015 to around $1000 per kg in August 2016.
The hepatitis B drug entecavir could be manufactured for aprice of $36 for a year’s treatment, and will go off patent in 2017, while tenofovir/lamivudinecould be manufactured for $67 a year, implying a hepatitis B treatment costalso below $90 a year.


         HIV drug costs: potential for 90% redu

StephenW

全球病毒性肝炎，艾滋病毒和结核病治疗需要新的$ 90- $ 90- $ 90目标
安德鲁·希尔在艾滋病毒格拉斯哥说。图片来源：HIV Drug Therapy Glasgow 2016
Keith Alcorn
发布时间：2016年10月24日

治疗病毒性肝炎，艾滋病毒和结核病（TB）的药物的费用现在如此之低，每种疾病可以治疗不到90美元，圣斯蒂芬艾滋病信托基金的安德鲁·希尔博士告诉国际药物治疗大会开幕全体会议在艾滋病毒感染（艾滋病毒格拉斯哥）星期天在格拉斯哥。

治疗结核病的仿制药的成本已经低于90美元，为期6个月的治疗课程，一些抗逆转录病毒治疗方案已经在低收入国家每年降至90美元以下。希尔医生说，乙型和丙型肝炎的通用治疗费用也在下降，有进一步减少的可能性。

Hill医生解释说，到2017年年底，应该可以在南非和欧洲以相同的价格治疗艾滋病毒，但是丙型肝炎治疗在高收入市场仍然非常昂贵，除非制药公司同意降低价格直接作用的抗病毒药物，以换取治疗更多患者的协议，如在澳大利亚。

由于规模经济，制造丙型肝炎直接作用抗病毒药物sofosbuvir和daclatasvir的原材料的成本下降，将12周疗程的可行性制造价格降至76美元，sofosbuvir / ledipasvir的可行价格$ 96，希尔博士告诉会议。

Sofosbuvir单独目前由吉利德科学公司在德国销售50,426欧元，是美国以外最高价格的市场。

Hill的研究小组能够通过分析印度内外药物制造原料中活性药物成分（API）的运输成本趋势，尽可能降低制造成本。通过计算进行一个疗程所需的API量，每片添加0.04美元用于赋形剂和压片，以及0.35美元的制剂成本，然后增加10-50％的利润率，研究人员可以计算一般的最小价格制造商可以做一个药物。

sofosbuvir API的价格从2015年1月的每公斤9000美元下降到2016年8月的每公斤1000美元左右。

乙型肝炎药物恩替卡韦的一年治疗价格为36美元，2017年将取消专利，而替诺福韦/拉米夫定的年生产量为67美元，这意味着乙型肝炎治疗费用也低于每年90美元。
艾滋病毒药物成本：可能减少90％