The Cost of a Cure

Doctors without Borders criticizes the pricing of a new life-saving TB treatment.

Like Comment

Anyone versed in social etiquette can tell you talking about money is gauche, even among friends. Talking about it in the context of drug pricing is even more taboo and explosive.

The past two years have seen several controversies over the price of life-saving drugs. In 2014, Gilead was criticized for pricing Solvadi, a game-changing drug licensed to cure Hepatitis C virus infection, at $1000 a day for a 12 week course of treatment. And last year, ex-CEO Martin Shkreli was dubbed the 'most hated man in America' for raising the price of an important (albeit scarcely used) drug to treat toxoplasmosis by 5000%.

This week, STAT news reports that Doctors with Borders (MSF) has raised objections to the pricing of a new drug, delamanid (marketed as Deltyba) for the treatment of multidrug resistant TB (MDR-TB). MDR-TB is resistant to front line drugs and typically requires long and complicated treatment regimens using less potent and more problematic second-line therapy. Therefore, any new therapy to help shorten treatment time, boost cure rates and reduce side-effects will offer a substantial improvement over the current clinical management of MDR-TB.

Deltyba is reported to be priced at $1700 for a 6 month course for middle-income and developing countries, who typically have the highest rates of TB. While funding of these drugs will partly come from private charities and public-private alliances, MSF worries that as Deltyba is designed to be taken in combination with other expensive existing drugs, the total treatment of an MDR-TB patient would near $4,500, which would rapidly deplete the healthcare budgets of many countries.

While it is unclear where the final price of Deltyba will end up (Solvadi and many other drugs have had their price lowered after lobbying from advocacy groups and further negotiation with governments), this newest case shows off the growing public perception that out-and-out pursuit of profits could come at the cost of making sure that those who need these drugs can access them.

While many factors go into the complex negotiation behind setting drug prices (e.g., the cost of research and development to bring these drugs to market; the size of the audience for the drug; the profit margins companies would like to achieve; the size of healthcare budgets), the inner workings of this process, at least in the public domain, remains rather murky.

Michael Chao

Project Manager, Harvard TH Chan School of Public Health

I first developed an interest in bacterial pathogenesis while at Cornell University. I then earned my PhD in Biomedical and Biological Sciences from Harvard University in Eric Rubin’s laboratory, studying cell wall remodelling in Mycobacterium tuberculosis. From 2012-2015, I continued my training as a postdoctoral fellow in Matthew Waldor’s lab at Harvard Medical School, investigating the role of DNA methylation on regulating fundamental cellular processes in Vibrio cholerae.