Intended for healthcare professionals

Analysis

Betting on hepatitis C: how financial speculation in drug development influences access to medicines

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3718 (Published 27 July 2016) Cite this as: BMJ 2016;354:i3718

Re: Betting on hepatitis C: how financial speculation in drug development influences access to medicines

The progress of drugs for Hepatitis C is indeed a milestone in the history of human medicine. Especially for countries and areas stricken by Hepatitis C, it appears like the light at the end of the tunnel. However, the high cost of the drugs acts as the darkness before the dawn, making the target appear available but far away. Just as Roy & King said, “the public is paying twice”1. This has become a serious problem for different health systems in the world2. Roy & King pointed out, the high prices have led many public systems across the US and Europe to treat only the sickest patients. But for Taiwan, the higher prevalence rate poses a serious dilemma (see Table).

In Taiwan, every type of viral hepatitis is prevalent. Though the National Health Insurance system is near perfect3, even today new drug treatment for hepatitis is not covered, let alone for the sickest patients. This is the first time that an effective drug is not covered just because of financial pressure since the National Health Insurance system was set up 21 years ago. Taiwan is the world’s first country to implement Hepatitis B vaccination nationwide, marking its 30th anniversary last month. The great irony is that the drugs for Hepatitis are not covered.

The pricing strategy has impact not only on medicine industries, but also on health systems. The value-based pricing, which decides the price of drug by its effects and values, is a tendency4 5. Thus, the drugs for Hepatitis C which enjoy 90% of cure rate should deserve higher prices.

However, once the overall health cost is too high, it will affect the allocation of resources in a country. In Taiwan, a doctor who enjoys high popularity in social media satirized the proposed coverage of new drugs for Hepatitis C by National Health Insurance in a national newspaper column, saying the proposal will be a disaster for the medical personnel6.

This kind of viewpoints is not uncommon. The proposed coverage of drugs for Hepatitis C accidentally sparked off the debate among doctors who as professionals fight for life of patients and as survivor under resources exclusion fight for the living of their own. Doctors by profession traditionally enjoy an altruistic image which faces challenge posed by the proposed coverage of drugs for Hepatitis C.

According to various economic indexes, Taiwan is among the developed countries7. Judged by robust economic performances and prosperous industries, Taiwan should not be included in “CHARITY PROGRAM” which enjoys the benefit of special drug prices. But Taiwan’s 4.4% of prevalence rate of Hepatitis C is three times the rate of the world average. Compared with those of the OECD countries, Taiwan’s prevalence rate is from triple to eightfold8.

The lowest price so far available by Ministry of Health and Welfare9 coincides with the fact that 0.66 million people need treatment8, so Taiwan will almost consume all the medicine expenses under National Health Insurance a year on the cost of drug for Hepatitis C. This is not the case of resources exclusion, but total replacement. If we give consideration to the price of drugs for Hepatitis C, the number of patients, the purchasing power of people and overall medicine expanses, we will have a reflection on the pricing of medicine from different angles. So far, for some developing countries, the price of medicine is lower10, mostly based on financial considerations. If only national finance is taken into consideration, it probably can’t include the overall impact on medical systems. Although Taiwan is among the developed countries, the prevalence rate is too high, leading to an impact on the resources and finance just like the developing countries.

Neither Taiwan nor Hepatitis C is alone. In the future, there will be more hard nuts to crack. By different cultural and geographic circumstances, some countries will face a similar problem which high prevalence rate will eventually wear down the nation’s finance. They don’t need a merciful pricing, but do need a pricing strategy which offers low unit price to let more people enjoy the fruits of medicine development.

References

1. Roy V, King L. Betting on hepatitis C: how financial speculation in drug development influences access to medicines. BMJ 2016;354.
2. Iyengar S, Tay-Teo K, Vogler S, et al. Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis. PLoS Med 2016;13(5):e1002032.
3. Reinhardt UE. Humbled in Taiwan. BMJ 2008;336(7635):72.
4. Bach PB, Pearson SD. Payer and Policy Maker Steps to Support Value-Based Pricing for Drugs. JAMA 2015;314(23):2503-4.
5. Reinhardt U. Probing Our Moral Values in Health Care: The Pricing of Specialty Drugs. JAMA 2015;314(10):981-2.
6. http://www.appledaily.com.tw/appledaily/article/headline/20160328/37132124/ (accessed 2016/08/08,in Chinese).
7. World Bank. World Bank list of economies, 2016.
8. Gower E, Estes C, Blach S, et al. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61(1 Suppl):S45-57.
9. http://www.cna.com.tw/news/firstnews/201607300142-1.aspx(accessed 2016/08/08,in Chinese).
10. Andrieux-Meyer I, Cohn J, de Araujo ES, et al. Disparity in market prices for hepatitis C virus direct-acting drugs. Lancet Glob Health 2015;3(11):e676-7.

Competing interests: No competing interests

09 August 2016
YAO-MAO CHANG
associate professor
Chi-Jeng Hsieh
Health Policy and Care Research Center, School of Health Care Administration, Taipei Medical University
250 Wuxing Street, Taipei, 11031, Taiwan