Cost of ‘repurposing’ existing drugs to treat COVID-19

By Dr. Ananya Mandal, MDApr 13 2020

Tens of thousands have died since the declaration of the COVID-19 pandemic by the World Health Organization (WHO). The virus – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of Betacoronavirus, and to date, no drug has been found to treat or cure the viral infection.

At present, the drugs used for the treatment of COVID-19 are the older drugs that were useful for other diseases. Now, researchers have published an article titled, “Minimum costs to manufacture new treatments for COVID-19,” in the latest issue of the Journal of Virus Eradication. The paper looks at repurposed drugs that might demonstrate efficacy against COVID-19, and if they could be manufactured profitably at very low costs to ensure affordable access to vital treatments for COVID-19 at low prices globally.

INOVIO Initiates Phase 1 Clinical Trial Of Its COVID-19 Vaccine. Image Credit: Anyaivanova / Shutterstock

What was this study about?

Using existing drugs which are useful for other diseases is called “repurposing” of the drug, explain the researchers. At present several drugs are being used against the infection, and some of these have shown efficacy in controlling the pandemic and reducing the death rates associated with the disease. At present, there are no drugs and no effective vaccines against the infection. The team wrote, “An effective vaccine may not be widely available until late 2021, even if trials are successful.”

Explaining the need to repurpose drugs, the team writes, “The shortened development timeline and reduced costs to this approach of using already existing compounds are particularly advantageous compared with new drug discovery in a pandemic situation, where time is of the essence.”

The team wrote, “If the 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.” Notable among these repurposed drugs are drugs useful against HIV - Lopinavir/Ritonavir, a drug against Ebola - Remdesivir and drugs against malaria - Chloroquine, and Hydroxychloroquine. Many of these drugs are at present undergoing human clinical trials across the world to find their efficacy and safety in COVID-19.

They explain the need for cost-effective drugs writing, “Low- and middle-income countries will need access to these treatments at minimum prices to ensure all those in need can be treated. Even in high-income countries, the burden of disease could be so great that access to drugs at minimum costs could also be necessary.”

What was done in the study?

For all the drugs that are being repurposed for therapy of COVID-19, the minimum cost of production was estimated using the costs of active pharmaceutical ingredients useful for the manufacture of the drugs. The methodology established was chosen to be the most cost-effective method for drug manufacture. The methods used to assess the minimum costs for such drug manufacture were the same as used for other infections such as HIV and hepatitis C.

The researchers also gathered data from the export shipment records from across the globe and analyzed the best-preferred routes of chemical analysis. The costs were compared with the price lists from various countries from which price data could be obtained.

What was found?

Some of the minimum manufacturing costs found for each of the drugs were listed as follows;

• Remdesivir (Drug useful against Ebola) - US $0.93/day. The team explains, “The 10-day course of treatment would, therefore, cost $4.80 per person. After adjustment for the cost of formulation (and 20% losses projected during formulation), cost of vials, profit margin, and tax, the estimated cost per treatment would be approximately $9 per person.”
• Favipiravir (Drug useful against flu) – U.S. $1.45/day
• Hydroxychloroquine (Drug useful against malaria) – U.S. $0.08/day
• Chloroquine (Drug useful against malaria) – U.S. $0.02/day
• Azithromycin (An antibacterial drug) – U.S. $0.10/day
• Lopinavir/ritonavir (Drugs useful against HIV) – U.S. $0.28/day
• Sofosbuvir/daclatasvir (antiviral drugs) – U.S. $0.39/day
• Pirfenidone (an anti-inflammatory useful in pulmonary fibrosis) – U.S. $1.09/day

The team of researchers wrote that the costs of production of the drugs ranged between $0.30 and $31 per treatment course. A treatment course ranged between 10 and 28 days. The team added that at present, the price of these drugs in the United States and other nations was much higher than the cost of their production.

Conclusions and implications

The team concluded that if these repurposed drugs were to be proved to be effective against, they could be “manufactured profitably at very low costs, for much less than current list prices.” The team wrote in conclusion, “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.”

Dr. Hill, a senior visiting research fellow at Liverpool’s department of translational medicine, said, “The main treatments being evaluated for coronavirus could be mass-produced for $1 per day or less.” “At these low prices, anyone needing treatment for coronavirus, in any country, should be able to access the treatment they need,” he noted.