Travelling to the United States with the hope of treating severe malaria could result in a financial nightmare as the Centre for Disease Control and Prevention (CDC) withdraws from supplying treatment to hospitals.
A returning traveller from a malaria-endemic country like Nigeria will only access Intravenous Artesunate, the only approved form of treatment, in commercial pharmacies at $60,000, Boghuma Titanji, a Cameroonian medical doctor and clinical researcher, said in a tweet.
Checks on the CDC website show that distribution to hospitals will be discontinued from September 30, 2022 as it is available in adequate supply from major drug distributors. According to the centre, severe malaria should be treated with intravenous (IV) antimalarial medications, as the first-line drug for the treatment of severe malaria in the US.
The drug used to be supplied to patients on request, free of charge by the CDC as a better standard for treating severe malaria. It was also a replacement for quinidine, a previously used drug produced by Eli Lilly, but which production stopped in 2017.
Artesunate made by Amivas LLC. Global health got approved in 2020 with a 150-fold hike in price to $30,000 for an average cost of treatment for an adult, making malaria treatment costlier to treat in the US than in low and middle-income African countries.
Amivas attributed the price hike to the cost of FDA licensing and production, combined with the small market for artesunate in the US, according to an advocacy piece written by Anne Frosch, assistant professor of medicine at the University of Minnesota; Aileen Ahiskali, an infectious diseases pharmacist at Hennepin Healthcare and Chandy John, a pediatric infectious diseases physician and professor of pediatrics and medicine at Indiana University School of Medicine.
The cost of the drug this year has doubled to $60,000, according to Titanji.
In a separate tweet, Stone Doggett, an infectious disease physician, and scientist at the Oregon Health and Science University said the cost of IV artesunate increases at least 10,000 times (over $35,000)
“I am very interested in the story behind a company being created to manufacture artesunate in partnership with the US Army, receiving exclusive rights and potentially a 100 million dollar transferable priority review voucher and settling on a $35,000 to $105,000 price tag,” Doggett said.
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Only about 300 people develop severe malaria in the US yearly and artesunate manufactured outside the US cannot be imported.
Malaria treatment in most African countries costs less than $5. In India, it is between $10 and $25 for an intravenous Artesunate course, depending on when the patient can be switched to oral treatment.
In their plea for urgent solutions in terms of pricing and availability, Frosch, Ahiskali and John said the financial crisis facing healthcare and the resulting lean hospital budgets mean that medication for uncommon diseases like malaria may not be stocked by most hospitals.
“When purchased after a case is diagnosed, because of its limited availability, distributors take anywhere from 12 hours, at best, to five days to deliver the drug, a dangerous delay in care,” they said.
According to Titanji, a returning traveller from a malaria-endemic region with severe malaria in the US could die before the hospital procures the drug due to cost.
Despite being an off-patent and widely used drug, she said the sales right is now owned by a few suppliers who have inflated the price for profit.
“The moral of this story is if you are travelling to a malaria-endemic part of the world from the US, obtain and take your malaria prophylaxis diligently because the US is the last place you want to have severe malaria right now. Our health system is broken,” she said.
