ECC 2015

Is it possible to develop cancer drugs at a lower cost?

Prof Andrew Hill - University of Liverpool, Liverpool, UK

Andrew, tell us a little bit about yourself and Liverpool, where you work, because it’s a hotbed of information about drug pricing, isn’t it?

I’m the Senior Research Fellow at Liverpool University in the Pharmacology Department and we’ve been looking at a whole range of drugs – drugs for HIV, drugs for hepatitis B, hepatitis C, small molecules.

Now, in the global battle against HIV big progress was made in getting the best drugs out there cheap enough to fight it. What about cancer, what have you been doing?

There was a time with HIV where drugs were $10,000 for a year of treatment and now they’re $100 and we think we can do the same thing for cancer. Drugs that cost $100,000, we believe, cost around $200-300 per person per year to make. We’ve looked at the drugs being exported from India, we have access to a database of all of these drugs being produced at quality and exported and we can see how much they really cost.

We’re looking at the TKIs which are very powerful life extending drugs, what have you done exactly?

We looked at five tyrosine kinase inhibitors for a range of cancers and we looked at the prices in various countries. Then we also looked at the exports of those drugs as raw materials from India all over the world and we can see how much it costs for a kilogram or a hundred kilograms of a drug like imatinib or lapatinib. We then know, looking at packaging costs, formulation costs, using established methods, that these drugs are actually very cheap to make, very simple.

Importantly, though, you have to build in a good profit margin for the companies so they have the research funding to make more drugs like this. Have you done that too?

We included a 50% profit margin for generic companies, that’s a level that they can live with and that’s a level that they do produce a lot of generic drugs at already. So you look at the market for drugs for tuberculosis, for hepatitis B, for HIV, they’re working by that model and it’s sustainable. We have 15 million people taking low cost treatments for HIV, why can’t we do the same thing for cancer?

Now, TKIs may cost thousands of dollars per year per patient for treatment, what are the figures that you got out of this now?

Overall drug prices in America are far higher than Europe, two to three times higher for all of the drugs we looked at. But even the drug prices in Europe are in the region of 50-100 times the cost of production. So there’s the potential and we only looked at drugs which will go generic within the next five years. So by 2020 you could have generic lapatinib, imatinib, erlotinib, a whole variety of TKIs for very low prices.

And you’re talking about hundreds of dollars, not thousands.

I’m talking about hundreds of dollars per person per year.

What should doctors take home from this?

They need to question why the prices of these drugs are so high in countries. In the UK we can’t even access a lot of these drugs. The Cancer Drugs Fund has de-listed dasatinib and lapatinib for breast cancer and leukaemia in the UK because the prices are so high. Fundamentally these drugs are cheap to make, they’re available in other countries for much lower prices. We need a middle ground, we need lower prices.

There must be a desire in the companies also to make additional profits from treating millions of patients.

Companies need to get used to treating large numbers of people for a small individual profit rather than treating a very small number of people for a large profit. They make money both ways but if they treat the large number of people they do so much more human good.

What’s the take home message for both companies and for doctors coming out of this? How would you sum that up?

I’d sum it up by saying HIV has been an amazing medical success story, we’ve got 15 million people on low cost treatment. It was only possible because these treatments were very, very cheap to make. We’ve found we can do the same thing for cancer so why don’t we do this again?

Andrew, thank you very much.