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Nigerians pay lowest for generic hepatitis C medicines, among countries with highest cases

Nigerians pay lowest for generic hepatitis C medicines, among countries with highest cases

Nigerians have been found to pay the lowest price for hepatitis C medicine as countries with a high burden of the disease pay higher than the benchmark prices available through global pricing agreements.

The Global Hepatitis Report 2024 shows that the lowest reported price of the sofosbuvir/daclatasvir (SOF/DAC) fixed-dose combination was from Nigeria, at US $60 for the 12-week course of treatment.

The regimen of SOF/DAC represents the combination of two direct-acting antiviral drugs approved to treat hepatitis C.

Low-income countries such as the Democratic Republic of the Congo pay as much as US$ 1050 for the same medicine. Cameroon pays $481, eight times higher than the benchmark price.

The 12-week medicine course is sold at a global benchmark price of US$60. However, only four of the 24 reporting countries paid prices at or below the benchmark.

The World Health Organisation report examines access to health products from 38 countries for the viral hepatitis response, which together account for about 80 percent of the global disease burden of viral hepatitis B and C.

Of these, 10 countries including China, India, Indonesia, Nigeria, Pakistan, Ethiopia, Bangladesh, Vietnam, Philippines, and the Russian Federation – account for nearly two-thirds of the burden.

With a total of 15.7 million cases, Nigeria carries 5.2 percent of the global disease burden of hepatitis B and C combined as of 2022, according to the Global Hepatitis Reporting System, WHO.

“Generic viral hepatitis medicines continue to be inexpensive, but too many countries are still not procuring medicines at these prices. The prices paid across and within WHO regions vary greatly, and many countries pay higher prices than global benchmarks, even if the drugs are off-patent, or if countries are included in voluntary licensing agreements or produce generic products locally,” the report stated.

“Viral hepatitis programmes can save considerable money if more low- and middle-income countries can purchase generic medicines at available benchmark prices.”

The report further indicates that access to viral hepatitis treatment has not yet shifted to a public health approach. Despite adopting WHO guidelines, implementation in most countries still lags and the availability of affordable and simplified regimens is limited, especially in primary health care.

Although Nigeria is one of the countries that have adopted the public health approach with the addition of hepatitis B and C vaccines to routine immunisation programmes, the challenge remains low uptake.

Nigeria introduced the monovalent HepB-BD vaccine, a three-dose schedule, into its routine immunisation schedule in 2004.

It is currently administered less than 24 hours of birth and a maximum of 2 weeks, while a hepatitis B-containing pentavalent vaccine (DTP-HepB-Hib) is given at 6, 10, and 14 weeks.

According to the National Primary Health Care Development Agency (NPHCDA), the effort is challenged by the fact that 61 percent of births in Nigeria are at home without skilled birth attendants; and only about 39 percent of births happen in a health facility.

Despite the hepatitis B birth dose vaccine being available, the coverage is still low even among births in health facilities.

“If a child has never received any vaccine, there are chances that the child has not received any other health benefit that should be received from the system. Those children are a marker of broader deprivation,” Muyi Aina, executive director, NPHCDA told BusinessDay earlier.

Although tenofovir disoproxil fumarate (TDF) for treatment of hepatitis B is off-patent and available at a global benchmark price of US$ 2.4 per month, the report shows that only seven of the 26 reporting countries paid prices at or below the benchmark.

The lowest reported monthly treatment prices reported by countries ranged from US$ 1.22 for 30 tablets in China and India to US$ 34.20 for 30 tablets in the Russian Federation.

When countries report the prices of multiple products, the range of prices paid can be much higher. In Viet Nam, the reported prices of generics range between US$ 2.1 and US$ 1849.6 for a monthly supply of a generic product.

The Democratic Republic of the Congo reports US$ 108 for a monthly supply of the originator product.

The report also found that product registration is lagging, including for medicines for children. Of 33 reporting countries, 28 (85 percent) have registered at least one product for TDF.

Twenty-four countries (73%) have registered SOF and DAC (both or a fixed-dose combination or co-blistered); and among these, only four – Cambodia, Myanmar, Nigeria and Uganda – reported registering the SOF/DAC fixed-dose combination.

WHO believes that universal access to prevention, diagnosis and treatment in these countries by 2026, together with a special effort in the African Region, will enable the global response to regain the trajectory needed to achieve the Sustainable Development Goals.

Its analysis of the long-term benefits in six results obtained from several countries’ investment case studies suggests that action to eliminate hepatitis C is taken now, the incidence will decline by 90 percent, mortality by 65 percent, and the costs of achieving global targets by 15 percent by 2030.

The benefits of achieving global goals will be apparent by 2030, saving 2.85 million lives and averting 9.5 million new viral hepatitis infections and 2.1 million cases of cancer.

Towards 2050, this will save nearly 23 million lives and prevent nearly 53 million new viral hepatitis infections and 15 million cases of cancer.