Abstract
Background
Repurposing existing drugs with known safety profiles remains an important strategy in the
global efforts to suppress the ongoing COVID-19 pandemic, although to-date, only
dexamethasone, a corticosteroid and tocilizumab/sarilumab, anti-IL6 receptor monoclonal
antibodies are found to reduce mortality in critical care settings. An effective drug for
treatment and prevention in the earlier stages of disease is yet to be found. Several new
candidates are now under clinical investigation including ivermectin and colchicine. If found
effective, they would need to be readily affordable and widely available for it to be useful
globally.
Methods
Costs of production for new and potential COVID-19 drugs (dexamethasone, ivermectin,
colchicine) were estimated using established methodology, using active pharmaceutical
ingredients (API) data extracted from global shipping records. The estimated costs were
compared against list prices from low, medium and high-income countries. List prices of
tocilizumab and sarilumab were also assessed. Annual API export volumes from India were
used to estimate the current availability of each drug.
Results
All three analysed drugs can be manufactured generically at very low cost: per-course costs
ranged between $2.58 for IV dexamethasone (or $0.19 orally) to $0.12 for ivermectin. When
compared against international list prices, we find large variations between different
countries. Overall, drug API availability was good, with colchicine being the most available
with sufficient API exported over a recent 12-month period sufficient for 59.8 million
treatment courses.
Conclusions
Analysed drugs are widely available and can be reasonably produced for less than $0.1 per
day in oral formulations.
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