Poll: At $14,105/Year, Is Dolutegravir Fairly Priced?

August 28, 2013

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price -- around $14k/year -- has generated some controversy.

For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors.

  • Raltegravir: $12,976
  • Elvitegravir: $13,428 (once disentangled from the price of TDF/FTC)
  • Dolutegravir: $14,105

If you add the $12 or 15K for the ABC/3TC or TDF/FTC respectively, you get the total cost of initial therapy. So these integrase-based regimens cost more than TDF/FTC/EFV (22.5K) or TDF/FTC/RPV (23.2K), and less than boosted atazanavir- or darunavir-based regimens, which are around 30k.

Now obviously these are all big numbers -- HIV treatment is expensive -- but the flip side is that it's so staggeringly effective that it generally meets acceptable criteria for cost-effectiveness given the huge added years of life.

But incremental cost-effectiveness is another matter -- meaning, is the additional cost of one drug over another justified, and/or good value?

Here, then, are two opposite perspectives on the dolutegravir pricing:

  1. The price is fair, according to the U.S.-based Fair Price Coalition. Dolutegravir is an improvement over currently available options, and the slight premium pricing over raltegravir and elvitegravir/cobicistat is justified. Furthermore, the company met with and heeded community advice on price before the release of the drug -- a laudable practice.
  2. The price is unfair, according to the advocacy group HIV i-Base, which is based in London. The makers of dolutegravir went "for gold" in pricing the drug in the United States, and will therefore severely limit the use of dolutegravir in Europe and likely also in resource-limited settings (though prices in these locations are not yet set).

Your thoughts?

Is dolutegravir fairly priced?

  1. Yes -- it's an improvement over current options, and this is in the range of what HIV treatment costs today.
  2. No -- all HIV treatment is too expensive, and this is just the latest extreme example.

[Editor's note: You can vote on this poll and view results by visiting the original blog post.]

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by Journal Watch. Journal Watch is a publication of the Massachusetts Medical Society.

Reader Comments:

Comment by: Schields (Raleigh, N.C.) Sat., Jun. 7, 2014 at 4:32 pm UTC
Why will I die because I can not afford $2,000 plus a month for Atripla here in the U.S. when If I lived in India I could live with $60. a month, South Africa - $30. a month. I guess I can die a miserable death here in the "land of the free, home of the brave" knowing that at least I didn't! contribute to the money -worshipping culture that we have become. Will miss my nieces & nephews, the fall colors, but not much else. Adios!
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Comment by: Hank (Philadelphia) Fri., Sep. 13, 2013 at 2:00 pm UTC
I feel like this may be a little Utopian of me but...HIV is a worldwide epidemic. There should be no difference in price between the US and some third world country. These prices should be fixed to cover the direct manufacturing cost, perhaps a scooch higher to cover the necc informational printing. I understand and respect the notion that years and years of R/D have gone into the release of new meds, but they are a sunk cost. There are very few people living here in the US who could afford to buy their medications at these prices, let alone parts of the world that live on $2 a day.

We have spent a lot of time in the last few years investigating the Year End Bonuses of major companies in the financial sector, dare we open the books of pharmaceutical companies and see how much they are getting paid out? I'm willing to bet you could pay cash for a dozen or more patients to take top of the line drugs off of just one executives bonus, saying nothing of what the entire executive team takes away at the E.O.Y.

The last disease we not only cured but eradicated was smallpox (which oddly enough we are now afraid of it being used as a biological weapon). Pharma-Execs should only ever be bonused when their company, under the individuals management has accomplished similar goals. The real mind blower is that I don't think these bonuses should come from revenue streams. They should be incentives from governments around the world. GSK, Merck, BMS and want a bonus, CURE something. I don't know about you, but I'd gladly throw a few extra bucks in taxes a year to establish a fund for these sorts of incentives.
Imagine how quickly ER's and clinics would see a decrease in admissions if quality vaccines and treatments were available to all. I'm not advocating free drugs for the planet, merely suggesting that companies reasses cost allocations/structures and profit margins/distribution.

Profiting from global suffering indefensible.
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Comment by: William (New jersey) Thu., Sep. 12, 2013 at 7:49 pm UTC
My atripla is $4900.00 for 3 months, almost 20 grand a year, unbelievable, just waiting for my health insurance to drop me so i can die, this life sucks!
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Comment by: Tim Sanders (Reno, NV.) Sun., Sep. 1, 2013 at 3:20 pm UTC
This is a tough one for me because I have some respect for any drug research/developer that is still in the HIV sphere. There is still so much to learn but the U.S. Congress is cutting research grants right and left, especially impacting HIV gov't. research and free access to treatment there. However, I was on AZT/DDI for over 18 years and the treatment costs for those two drugs still cost me over 12 thousand dollars a year. This is for a drug that was developed in the late 50's/60's as a cancer treatment. It had no positive affect on cancer and set on the shelf for 30 years, yet people were still charged exorbitant prices for the drugs which had long ago received their tax credits for development and research. These drugs were so cheap to make that India refused to abide by the International agreements on drug development of generics. Obviously in a new investigational drug, this cost is justified, depending on your outlook on corporate taxes and profits. To remedy this, there should be more research and development at the NIH and CDC which already have an infrastructure for this and is paid for by U.S. citizen taxes. Any cuts in financing this research should be met with immediate voter education to insure that those politicians voting against the welfare of U.S. citizens and people afflicted around the world are held accountable for their actions and removed from office. In addition, government financing should insure cost effective R and D and the most efficient and productive development of new drugs. Current red tape and redundant paper work and the perceived superiority of one researcher over another should be closely monitored to assure the public that these government agencies are running as medical research institutes, not stepping stones for individual doctors and researchers to a higher political position or individual monetary gain.
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