{"id":4522,"date":"2013-08-28T08:03:25","date_gmt":"2013-08-28T12:03:25","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4522"},"modified":"2015-06-04T14:33:10","modified_gmt":"2015-06-04T18:33:10","slug":"poll-at-14105year-is-dolutegravir-fairly-priced","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/poll-at-14105year-is-dolutegravir-fairly-priced\/2013\/08\/28\/","title":{"rendered":"Poll:  At $14,105\/year, Is Dolutegravir Fairly Priced?"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2013\/08\/12721468_blog1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-4544\" alt=\"12721468_blog\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2013\/08\/12721468_blog-200x3001.jpg\" width=\"200\" height=\"300\" \/><\/a>The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price &#8212; <a href=\"http:\/\/www.fiercepharma.com\/story\/viivs-newly-minted-hiv-fighter-tivicay-cost-14k-year\/2013-08-13\" target=\"_blank\">around $14k\/year<\/a> &#8212; has generated some controversy.<\/p>\n<p>For the record, here are the per-year <a href=\"http:\/\/www.fdbhealth.com\/policies\/drug-pricing-policy\/\" target=\"_blank\">wholesale acquisition costs<\/a> of the three FDA-approved integrase inhibitors.<\/p>\n<ul>\n<li><span style=\"line-height: 13px\">Raltegravir: \u00a0$12,976<\/span><\/li>\n<li><span style=\"line-height: 13px\">Elvitegravir: \u00a0$13,428 (once disentangled from the price of TDF\/FTC)<\/span><\/li>\n<li><span style=\"line-height: 13px\">Dolutegravir: \u00a0$14,105<\/span><\/li>\n<\/ul>\n<p>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.<\/p>\n<p>Now obviously these are all big numbers &#8212; HIV treatment <em>is<\/em> expensive &#8212; but the flip side is that it&#8217;s so staggeringly effective that it generally meets acceptable criteria for cost-effectiveness given the huge added years of life.<\/p>\n<p>But <em>incremental<\/em> cost-effectiveness is another matter &#8212; meaning, is the additional cost of one drug over another justified, and\/or good value?<\/p>\n<p>Here, then, are two opposite perspectives on the dolutegravir pricing:<\/p>\n<ol>\n<li><span style=\"line-height: 13px\"><strong><a href=\"http:\/\/fairpricingcoalition.org\/2013\/08\/14\/fpc-commends-viiv-healthcare-on-price-of-its-new-drug-tivicay\/\" target=\"_blank\">The price is fair<\/a>,<\/strong> according to the U.S.-based <a href=\"http:\/\/fairpricingcoalition.org\/home\/\" target=\"_blank\">Fair Price Coalition<\/a>. 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 &#8212; a laudable practice.<\/span><\/li>\n<li><a href=\"http:\/\/i-base.info\/viiv-goes-for-gold\/\" target=\"_blank\"><strong>The price is unfair<\/strong><\/a>, according to the advocacy group <a href=\"http:\/\/i-base.info\/about-us\/what-we-do-and-why\/\" target=\"_blank\">HIV i-Base<\/a>, which is based in London. The makers of dolutegravir went &#8220;for gold&#8221; 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).<\/li>\n<\/ol>\n<p>Your thoughts?<\/p>\n<div id=\"polls-14\" class=\"wp-polls\">\n\t<form id=\"polls_form_14\" class=\"wp-polls-form\" action=\"\/index.php\" method=\"post\">\n\t\t<p style=\"display: none;\"><input type=\"hidden\" id=\"poll_14_nonce\" name=\"wp-polls-nonce\" value=\"8a00a1916b\" \/><\/p>\n\t\t<p style=\"display: none;\"><input type=\"hidden\" name=\"poll_id\" value=\"14\" \/><\/p>\n\t\t<p style=\"text-align: center;\"><strong>Is dolutegravir fairly priced?<\/strong><\/p><div id=\"polls-14-ans\" class=\"wp-polls-ans\"><ul class=\"wp-polls-ul\">\n\t\t<li><input type=\"radio\" id=\"poll-answer-43\" name=\"poll_14\" value=\"43\" \/> <label for=\"poll-answer-43\">Yes -- it's an improvement over current options, and this is in the range of what HIV treatment costs today.<\/label><\/li>\n\t\t<li><input type=\"radio\" id=\"poll-answer-44\" name=\"poll_14\" value=\"44\" \/> <label for=\"poll-answer-44\">No -- all HIV treatment is too expensive, and this is just the latest extreme example.<\/label><\/li>\n\t\t<\/ul><p style=\"text-align: center;\"><input type=\"button\" name=\"vote\" value=\"   Vote   \" class=\"Buttons\" onclick=\"poll_vote(14);\" \/><\/p><p style=\"text-align: center;\"><a href=\"#ViewPollResults\" onclick=\"poll_result(14); return false;\" title=\"View Results Of This Poll\">View Results<\/a><\/p><\/div>\n\t<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price &#8212; around $14k\/year &#8212; has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir: \u00a0$12,976 Elvitegravir: \u00a0$13,428 (once disentangled from the price of TDF\/FTC) Dolutegravir: [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[87,266,284,307,316,779,814],"class_list":["post-4522","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-atazanavir","tag-darunavir","tag-dolutegravir","tag-efavirenz","tag-elvitegravir","tag-raltegravir","tag-rilpivirine"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4522","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=4522"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4522\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=4522"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=4522"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=4522"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}