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Cheap is in the Eye of the Beholder

Cheap is in the Eye of the Beholder

The title says it all:  “Cheap malaria drug could treat colorectal cancer effectively too, say experts.

From a malaria treatment perspective, however, this quickly becomes a case of Miles’ law—“where you stand depends on where you sit.”

The drug in question is artesunate, one of the artemisinin derivatives that currently occupy the front ranks of malaria treatment. Artemisinins became commercially viable in Africa around 2001, when the first artemisinin-combination therapy (ACT), Coartem, was officially sanctioned (“pre-qualified”) by the World Health Organization. But at more than $2 per course of treatment, Coartem was unaffordable to most malaria sufferers and threatened to break the bank of aid agencies, including USAID.  In the malaria world, it was in the Cadillac price range. The practical question asked then was how long countries could afford to wait to adopt an artemisinin-containing regimen as first-line treatment, and how they would strategize the wait time against rising resistance levels.  Their options were sticking to cheap (10 cents per course) chloroquine, with high levels of drug resistance already showing, or changing first to similarly-priced sulphadoxine-pyrimethamine (SP), knowing that resistance would reach high levels in a short span of years.

Price is still an issue for people self-treating their presumed malaria (which is frequently not malaria but a self-limited viral infection). Even at clinics, where the drug is theoretically free or subsidized, stockouts are common and patients end up having to spend their own money to buy from the private sector.

Compared to other cancer drugs, artesunate is very cheap—not much different than free. The fact is we should always have considered it a bargain for malaria, too, but minds had been set by the really cheap drugs the world was used to.  It’s true that colorectal cancer is much rarer than malaria, so even with the higher baseline dosage for cancer treatment the total global cost of treating this cancer with artesunate is likely less than the total cost of treating malaria globally, but even that should have been (and should still be) seen as a bargain. 

Hellen Gelband is the Associate Director of the Center for Disease Dynamics, Economics and Policy.

Artesunate image courtesy Wikimedia Commons.