Publications

2021
Melissa J Barber, Ameet Sarpatwari, and Christa Cepuch. 12/7/2021. “COVID-19 antivirals must not affect HIV drug supply.” The Lancet HIV. Publisher's Version
2020
Melissa J Barber, Dzintars Gotham, Giten Khwairakpam, and Andrew Hill. 9/2020. “Price of a hepatitis C cure: Cost of production and current prices for direct-acting antivirals in 50 countries.” Journal of Virus Eradication, 6, 3. Publisher's Version
Dzintars Gotham, Melissa J Barber, and Andrew Hill. 6/1/2020. “How a US-UK trade agreement could affect NHS drug prices.” BMJ, 369, 1332. Publisher's Version
2019
10/2019. Pulling together to beat superbugs: knowledge and implementation gaps in addressing antimicrobial resistance. The World Bank. Publisher's Version
D Gotham, M.J. Barber, and A.M. Hill. 9/30/2019. “Estimation of cost-based prices for injectable medicines in the WHO Essential Medicines List.” BMJ Open, 9, 9, Pp. e027780. Publisher's Version
Neesha Rockwood, Maddalena Cerrone, Melissa Barber, Andrew M Hill, and Anton L Pozniak. 7/18/2019. “Global access of rifabutin for the treatment of tuberculosis – why should we prioritize this?” Journal of the International AIDS Society., 22, 7.
Ellen 't Hoen, Salomé Meyer, Patrick Durisch, Wilbert Bannenberg, Katrina Perehudoff, Tim Reed, and Melissa J Barber. 7/11/2019. “Improving affordability of new Essential Cancer Medicines.” The Lancet Oncology.
2018
Dzintars Gotham, Melissa J Barber, and Andrew Hill. 9/25/2018. “Production costs and potential prices for biosimilars of human insulin and insulin analogues.” BMJ Global Health, 3, 5. https://gh.bmj.com/content/3/5/e000850Abstract

Introduction High prices for insulin pose a barrier to treatment for people living with diabetes, with an estimated 50% of 100 million patients needing insulin lacking reliable access. As insulin analogues replace regular human insulin (RHI) globally, their relative prices will become increasingly important. Three originator companies control 96% of the global insulin market, and few biosimilar insulins are available. We estimated the price reductions that could be achieved if numerous biosimilar manufacturers entered the insulin market.

Methods Data on the price of active pharmaceutical ingredient (API) exported from India were retrieved from an online customs database. Manufacturers of insulins were contacted for price quotes. Where market API prices could not be identified, prices were estimated based on comparison of similarity, in terms of manufacturing process, with APIs for which prices were available. Potential biosimilar prices were estimated by adding costs of excipients, formulation, transport, development and regulatory costs, and a profit margin.

Results The manufacturing processes for RHI and insulin analogues are similar. API prices were US$24 750/kg for RHI, US$68 757/kg for insulin glargine and an estimated US$100 000/kg for other analogues. Estimated biosimilar prices were US$48–71 per patient per year for RHI, US$49–72 for neutral protamine Hagedorn (NPH) insulin and US$78–133 for analogues (except detemir: US$283–365).

Conclusion Treatment with biosimilar RHI and insulin NPH could cost ≤US$72 per year and with insulin analogues ≤US$133 per year. Estimated biosimilar prices were markedly lower than the current prices for insulin analogues. Widespread availability at estimated prices may allow substantial savings globally.

Andrew Hill, Melissa Barber, and Dzintars Gotham. 1/1/2018. “Estimated costs of production and potential prices for the WHO Essential Medicines List.” BMJ Global Health, 3, 1. http://dx.doi.org/10.1136/bmjgh-2017-000571Abstract

Introduction There are persistent gaps in access to affordable medicines. The WHO Model List of Essential Medicines (EML) includes medicines considered necessary for functional health systems.

Methods A generic price estimation formula was developed by reviewing published analyses of cost of production for medicines and assuming manufacture in India, which included costs of formulation, packaging, taxation and a 10% profit margin. Data on per-kilogram prices of active pharmaceutical ingredient exported from India were retrieved from an online database. Estimated prices were compared with the lowest globally available prices for HIV/AIDS, tuberculosis (TB) and malaria medicines, and current prices in the UK, South Africa and India.

Results The estimation formula had good predictive accuracy for HIV/AIDS, TB and malaria medicines. Estimated generic prices ranged from US$0.01 to US$1.45 per unit, with most in the lower end of this range. Lowest available prices were greater than estimated generic prices for 214/277 (77%) comparable items in the UK, 142/212 (67%) in South Africa and 118/298 (40%) in India. Lowest available prices were more than three times above estimated generic price for 47% of cases compared in the UK and 22% in South Africa.

Conclusion A wide range of medicines in the EML can be profitably manufactured at very low cost. Most EML medicines are sold in the UK and South Africa at prices significantly higher than those estimated from production costs. Generic price estimation and international price comparisons could empower government price negotiations and support cost-effectiveness calculations.

2016
Barber M, Gotham D, Muntanya J, and Balasubramian T. 12/9/2016. “Open letter to the candidates for Director-General of the World Health Organization: Will you support an R&D agreement that puts patient needs at the centre of R&D.” The Lancet Global Health, 5, 2, Pp. PE135-E136.
Adamjee R, Aykea R, Barber M, Browne J, Cubahiro N, Jarvis J, Lander F, Li S, Mishra S, Akhoondinasab M, Nurkhametova D, Omobo O, Onarheim K, Ramachandran R, Rasmussen R, Sharma A, and Walker A. 11/7/2016. “Youth Commission on Essential Medicines Policies.” The Lancet, 389, 10067, Pp. 345-347. https://doi.org/10.1016/S0140-6736(16)31906-7
Gotham D, Onarheim KH, and Barber MJ. 5/31/2016. “How the MDGs gave up on measuring access to medicines.” The Lancet Global Health, 4, 5, Pp. 296-297. https://doi.org/10.1016/S2214-109X(16)00066-8