DR KIERAN HARKIN recently made me aware of a group he is a member of called Access to Medicines Ireland – their objective is to ensure that new medicines are developed for the benefit of public health, rather than private gain.

The current system permits the inventor of a new drug to charge whatever price they believe the market will bear.  Drugs used to treat hepatitis C are a good example of the problem created for society by this system.  

In Ireland, Hepatitis C  drugs have a list price of €46,000 for a 12-week course even though we know that the manufacturing price is a mere €106. 

While the HSE has negotiated a better price, the details have not been made public due to a confidentiality agreement. We do know however that the HSE has a budget of €30 million to treat around 1,800 patients. That works out at €16,700 per 12-week course.

Hepatitis C

Over the years I have sat with many disappointed people after they had been refused medication for Hepatitis C.

Usually, the reason they were given was that they didn’t meet the criteria, due to not having been alcohol-free for long enough or not having stable accommodation to live in.

One young man was told that he would need to come off methadone; a drug that had allowed him to be stable for over three years and to return to the workforce.

For a condition that is curable it is outrageous that such barriers to access existed.

Many people working in addiction services believed that the criteria were so strict because the treatment is so expensive – that the health service was looking for ways to reduce access to that treatment. 

But Dr Harkin says that things have changed a lot recently, and the constraints on access to treatment are no longer because of the price but because of the capacity of the service to deliver the treatment.

The HSE states that it is on target to eradicate Hepatitis C in Ireland by 2026.  

Basically, we are paying €30 million a year for drugs whose manufacturing price is less than €200,000. Effectively on that one drug alone, we are wasting €28.8 million which is badly needed in other areas of public service.

What is much worse is that while we in Ireland can stretch ourselves to pay these astronomical prices, people living in poorer economies are less fortunate.

Globally Hepatitis C affects more than 71 million people and kills close to 400,000 people a year.

A UK activist group, Global Justice Now, estimates that somebody dies of Hepatitis C every 79 seconds while during that same 79 seconds, the drug company Gilead makes $26,000 selling the drug Sofosbuvir.

Sofosbuvir is one of the main drugs used to treat Hepatitis C and Gilead makes a staggering $30bn in profit from it every year.   

Cancer

Now new cancer treatments being developed look set to be restricted because of the price too.

A group of drugs called CAR-T are in the early stages of development but have been shown to cure certain forms of cancer in children and their use is likely to expand to adults. 

They work by taking white blood cells from the patient and effectively training these cells to fight cancer and then reinfusing the patient with the trained cell.  

According to Dr Harkin, the big problem with CAR-T treatments is going to be the price.

Both the major CAR-T drugs were approved in autumn 2017 by US agency the FDA. One was listed priced at $475,000 and the other at $373,000.  They are once-off treatments. 

This position has received significant support from the EU, in particular, the Dutch president, but the interests and influence of the pharmaceutical industry are pervasive.

Accessing treatment and good health in Ireland comes at a huge cost. We need changes to the system fast – it is totally wrong to price people out of life.