Hepatitis C treatment costs could fall to $200 per treatment course for much of the world after 2025

Keith Alcorn
12 July 2013

Within 15 years, it may be possible to cure hepatitis C for $100-200 for a 12-week treatment course using two direct-acting antivirals plus ribavirin produced by generic manufacturers, according to an analysis of the potential for cost savings through generic drug production presented by Dr Andrew Hill of the University of Liverpool earlier this month at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur, Malaysia.

Current costs for hepatitis C triple therapy comprising pegylated interferon, ribavirin and a first-generation direct-acting antiviral range from $38,568 for a boceprevir-containing regimen in the United Kingdom to around $67,000 for a course of treatment containing telaprevir in the United States.

Improvements in hepatitis C therapy are likely to remain out of the reach of many people who need them. In India, for example, it is estimated that around 18 million people have hepatitis C, while in Indonesia 9 million people have hepatitis C.

Although prices for pegylated interferon and ribavirin have fallen as a result of negotiation in some lower middle-income countries, the cost of direct-acting antivirals is likely to remain unaffordable for most people in low- and middle-income countries. Although manufacturers have given no indication of the prices they will charge for interferon-free regimens, financial analysts expect to see pricing in the region of $60,000-70,000 in the United States.

Since 2000, the cost of antiretroviral drugs (drugs used to treat HIV) in low- and middle-income countries has declined as generic manufacturers in India have begun to produce versions of branded products. Although this move was at first fiercely resisted by some pharmaceutical companies, almost all drugs used in HIV treatment in low- and middle-income countries are now manufactured in India or South Africa by generic producers, often on license from the patent owner.

As a result of these changes, the cost of antiretroviral therapy for these countries has fallen from more than $10,000 a year in 2000 to less than $200 a year in 2013 (although middle-income countries outside Africa continue to pay considerably more).

This process of price reduction has been assisted by the expiry of patent protection on some key products, together with the lack of patent protection on older products. Patent protection on direct-acting antivirals currently in development will begin to expire from 2025, although opportunities for generic production as a result of voluntary licensing may exist before patents on some products expire.

The cost of drugs is also determined by the chemicals required to manufacture them, and the complexity of the chemical processes involved.

Using data on antiretroviral drug costs gathered by Médecins Sans Frontières, the researchers were able to define price ranges for the production of drugs of similar chemical structure, complexity and total weight. They used these price ranges to estimate the cost of a number of direct-acting antivirals now in phase III development, and to estimate the costs of a number of interferon-free combinations of these drugs already tested in phase II studies.

Analysis of the chemical structure of direct antivirals for hepatitis C treatment reveals that they are similar in molecular weight, complexity and structure to antiretroviral drugs used in HIV treatment. This means that similar chemical products and processes will be required to manufacture both classes of drug, allowing the researchers to estimate that the cost of new direct-acting antivirals for hepatitis C will be no more than ten times higher than the cost of manufacturing antiretroviral drugs.

Potential product cost



Estimated cost for 12-week course








NS5a inhibitor



Nucleotide analogue, complex synthesis



Protease inhibitor



Protease inhibitor: more complex structure


 Potential regimen costs



Estimated cost

Daclatasvir & sofosbuvir

12 weeks


Daclatasvir & sofosbuvir

24 weeks


Sofosbuvir & ribavirin

12 weeks


Sofosbuvir & ribavirin

16 weeks


Sofosbuvir & simeprevir & ribavirin

12 weeks


Sofosbuvir & simeprevir

12 weeks


The authors caution that more precise estimates of production costs will require production of pilot batches of products, as well as more detailed process chemistry. They also note that, as in the case of HIV, further reductions in cost could be achieved through work to optimise chemical synthesis and cheaper sourcing of raw materials. In the case of antiretroviral drugs for HIV, the Clinton HIV Access Initiative worked with generic pharmaceutical manufacturers in India, and raw material manufacturers in China, to re-engineer manufacturing processes to bring down the production costs of some newer antiretrovirals by 20 to 30%.


Hill A et al. What is the minimum cost per person to cure HCV? 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Kuala Lumpur, abstract TuLBPe16, 2013. (View a pdf version of the poster presentation on the conference website)