Minimum costs to manufacture new treatments for COVID-19

Abstract

Introduction: 'Repurposing' existing drugs to treat COVID-19 is vital to reducing mortality and controlling the pandemic. Several promising drugs have been identified and are in various stages of clinical trials globally. If efficacy of these drugs is demonstrated, rapid, mass availability at an affordable cost would be essential to ensuring equity and access especially amongst low- and middle-income economies.

Methods: Minimum costs of production were estimated from the costs of active pharmaceutical ingredients using established methodology, which had good predictive accuracy for medicines for hepatitis C and HIV amongst others. Data were extracted from global export shipment records or analysis of the route of chemical synthesis. The estimated costs were compared with list prices from a range of countries where pricing data were available.

Results: Minimum estimated costs of production were US $0.93/day for remdesivir, $1.45/day for favipiravir, $0.08/day for hydroxychloroquine, $0.02/day for chloroquine, $0.10/day for azithromycin, $0.28/day for lopinavir/ritonavir, $0.39/day for sofosbuvir/daclatasvir and $1.09/day for pirfenidone. Costs of production ranged between $0.30 and $31 per treatment course (10-28 days). Current prices of these drugs were far higher than the costs of production, particularly in the US.

Conclusions: Should repurposed drugs demonstrate efficacy against COVID-19, they could be manufactured profitably at very low costs, for much less than current list prices. Estimations for the minimum production costs can strengthen price negotiations and help ensure affordable access to vital treatment for COVID-19 at low prices globally.

Keywords: COVID-19; SARS-CoV2; access to medicines; drug prices.

Figure 1.

Chemical structures of candidate drugs

Figure 2.

(a) Flowchart to show the calculation of treatment costs for remdesivir. (b) Flowchart to show the calculation of treatment costs for favipiravir. OD: once daily; BD; twice daily.

Figure 3.

(a) List price cost of lopinavir/ritonavir in selected countries for 14-day treatment (400/100 mg twice daily). (b) List price cost of hydroxychloroquine in selected countries for 14-day treatment (400 mg once daily). (c) List price cost of chloroquine in selected countries for 14-day treatment (155 mg chloroquine base once daily). (d) List price cost of azithromycin in selected countries for 14-day treatment (500 mg once daily). (e) List price cost of sofosbuvir/daclatasvir in selected countries for 14-day treatment (400/60 mg once daily). (f) List price cost of pirfenidone in selected countries for 28-day treatment (801 mg three times daily). (g) List price cost of IV tocilizumab in selected countries for single dose (560 mg).

Figure 3.

(a) List price cost of lopinavir/ritonavir in selected countries for 14-day treatment (400/100 mg twice daily). (b) List price cost of hydroxychloroquine in selected countries for 14-day treatment (400 mg once daily). (c) List price cost of chloroquine in selected countries for 14-day treatment (155 mg chloroquine base once daily). (d) List price cost of azithromycin in selected countries for 14-day treatment (500 mg once daily). (e) List price cost of sofosbuvir/daclatasvir in selected countries for 14-day treatment (400/60 mg once daily). (f) List price cost of pirfenidone in selected countries for 28-day treatment (801 mg three times daily). (g) List price cost of IV tocilizumab in selected countries for single dose (560 mg).

Figure 3.

(a) List price cost of lopinavir/ritonavir in selected countries for 14-day treatment (400/100 mg twice daily). (b) List price cost of hydroxychloroquine in selected countries for 14-day treatment (400 mg once daily). (c) List price cost of chloroquine in selected countries for 14-day treatment (155 mg chloroquine base once daily). (d) List price cost of azithromycin in selected countries for 14-day treatment (500 mg once daily). (e) List price cost of sofosbuvir/daclatasvir in selected countries for 14-day treatment (400/60 mg once daily). (f) List price cost of pirfenidone in selected countries for 28-day treatment (801 mg three times daily). (g) List price cost of IV tocilizumab in selected countries for single dose (560 mg).