Globally, between 150 and 180 million people are infected with the hepatitis C virus, including approximately five million people co-infected with HIV. Roughly half (80 million) of all people living with hepatitis C are in the Asia-Pacific region, the majority in low- and middle- income countries where the high cost of treatment has often prevented those in need from accessing it. In February, Merck announced it would reduce the price of its hepatitis C treatment, pegylated interferon, by about 50%, to US$40 per weekly dose, in 57 low-income countries.
One dose of Merck’s pegylated interferon alpha 2b.
The cost of a course of therapy in the region has ranged between US$18,000 and US$33,000, and TREAT Asia and its national and regional partners have been urging pharmaceutical companies to cut the cost of pegylated interferon, an injectable drug, which is usually combined with the oral drug ribavirin. Together, this combination remains the current standard of care for treating hepatitis C in the developing world.
In July 2013, TREAT Asia and its partners submitted a letter to the CEOs of Merck and Roche, which both produce pegylated interferon. The letter described how the high cost of the drug blocks treatment access and leads to serious health consequences, stating, “Despite scale-up of antiretroviral treatment and improved control of HIV disease progression in our region, people living with HIV are increasingly dying of hepatitis C-related complications.” Merck is the first to offer new access pricing. “This price reduction provides an opportunity for governments to start implementing national programs addressing hepatitis C and is an important step to expand access to hepatitis C treatment,” says Giten Khwairakpam, TREAT Asia community and policy project manager.
The price reduction applies to World Bank-defined low-income countries and UN-defined least-developed countries. The Asian countries that qualify are Afghanistan, Bangladesh, Bhutan, Cambodia, Laos, Myanmar, Nepal, and North Korea. Countries that are not eligible include China, India, Indonesia, and Pakistan, which constitute four of the five countries with the largest numbers of people living with hepatitis C. Merck has stated that it will also offer some middle-income countries access pricing that is lower than pricing in high-income countries; however, hepatitis C treatment is not currently covered by most middle-income government healthcare programs, and it remains unclear whether these price reductions will be enough to change national policies.
Thailand became the first country in the region to provide pegylated interferon as part of government-supported healthcare in 2012. This has initially been restricted to those with hepatitis C infection alone, but Thailand is considering expanding access to include those living with HIV later in 2014. Unless Merck’s access pricing causes other middle-income countries to follow Thailand’s lead, and unless the pricing includes those countries with the highest disease burden, the numbers of patients in Asia able to access hepatitis C treatment will remain limited.