Table 2 shows the calculated cost of production, as well as the minimum and maximum available price for each drug. Pricing trends of export data for each medication throughout 2021, where available, are presented as bubble plots in the Appendix.
Our analysis used a 5-day, 800mg twice a day course, as reflected in the MOVe-Out trial . The weighted mean API cost in 2021 was $1,293/kg. After factoring in the costs of excipients, formulation, tax, and profit, a 5-day oral course could be manufactured for an estimated $12.40 per patient (Figure 1a).
International list prices per single dose of molnupiravir ranged between $750 per course in Japan to $20 in India (Figure 1b).
Figure 1c shows the cost per kg of molnupiravir throughout 2021 as reported by Panjiva. The price of molnupiravir API stayed relatively constant throughout the year.
Our analysis of nirmatrelvir used a dose of 300mg twice daily for 5 days, in combination with 100mg of ritonavir, consistent with NIH recommendations . The weighted mean API cost was $16,614/kg for nirmatrelvir and $221/kg for ritonavir. This corresponds to the estimated cost of a combined 5-day oral treatment of nirmatrelvir/ritonavir of $59 per patient (Appendix 1a).
International list prices per course of nirmatrelvir/ritonavir are limited in availability and ranged between $530 in the United States to $93 per course in Bangladesh (Figure 2a).
Our analysis of baracitinib used a dose of 4mg once daily for 14 days, consistent with WHO recommendations . The API cost of imports from 2021 was $6,624/kg. After including costs of formulation, a 14-day oral course could be manufactured for $0.60 per patient (Appendix 2a).
International list prices per course of baricitinib ranged between $2,422 in the US and $544 in the UK to $4.22 in India (Figure 2b). The United States price was slightly lower through the Veterans affairs system compared to standard pharmacy prices, at $2,045 per course.
For dexamethasone, the dose of 6mg once daily for 10 days used in our analysis, is the same dose used in the RECOVERY trials . The weighted average API cost of available export data was $1,068/kg. After the addition of costs, a 10-day oral course could be manufactured for $0.19 per patient (Appendix 3a).
International list prices per single dose of dexamethasone ranged between $21 per course in US pharmacies to $0.02 in Vietnam (Figure 2c).
Tenofovir disoproxil fumarate (TDF)/Emtricitabine (FTC)/Dolutegravir (DTG):
Our analysis used a 300mg/200mg/50mg once daily dosage for TDF/FTC and dolutegravir, as per FDA guidelines . The weighted mean API cost was $141/kg for TDF, $361/kg for FTC, and $668/kg for Dolutegravir. This corresponds to the estimated cost of TDF/FTC/dolutegravir of $74 per patient per year (Appendix 4a).
Current international list prices for a combined dose ranged from $36,374 per course in US pharmacies to $605 per course in India (Figure 2d). The PAHO price list shows a minimum pricing of $61 per patient per year . Prices extracted for the US, UK, and India used a combination dose of TDF/3TC plus dolutegravir. As FTC and 3TC can be used interchangeably, availability of FTC varies upon region .
Tenofovir alafenamide (TAF)/Emtricitabine (FTC)/Dolutegravir (DTG):
The weighted mean API cost of the available TAF export data was $3,114/kg. After the addition of costs, this TAF could be manufactured for $38 per patient per year. The combined treatment of TAF/FTC is prescribed with a 50mg dose of dolutegravir .
As a combined dose the production cost of TAF/FTC/Dolutegravir is estimated at $89 per patient (Appendix 5a)
International list prices for a combined dose of TAF/FTC/DTG ranged from $50,473 in US pharmacies, to $14,043 in the United Kingdom. The price of TAF/FTC/dolutegravir in the US was only slightly lower through the Veterans affairs system at $38,963 per course. The PAHO database shows price of $60 per patient per year  (Figure 2e).
Tenofovir disoproxil fumarate (TDF)/ Emtricitabine (FTC) (PrEP):
TDF is used with FTC (PrEP) at a dose of 300mg/200mg one daily for 365 days . Using the weighted mean calculated above, the combined estimated cost of PrEP per patient per year is $59 (Appendix 6a).
International list prices of PrEP range from $21,402 in US pharmacies to $16 in Vietnam (Figure 2f).
Darunavir 800mg is used with ritonavir 100mg once daily  as reflected by NICE recommendations . The weighted API costs of darunavir and ritonavir were $774/kg and $221/kg, respectively. As a combined dose, the production cost of darunavir/ritonavir is estimated at $286 per patient (Appendix 7a).
Current list prices for oral darunavir/ritonavir ranged from $24,773 per course in the US to $945 in Turkey (Figure 2g). The PAHO database shows a minimum price of $702 per year. .
The weighted mean API cost of atazanavir export data was $702/kg. After factoring in costs, a combined dose of atazanavir/ritonavir could be manufactured for $109 per patient per year (Appendix 8a). The atazanavir/ritonavir dose of 300/100 mg once daily is reflective of EMA and UK BNF regulations . International list prices of atazanavir/ritonavir ranged between $4,995 per year in US pharmacies to $363 in India (Figure 2h). The PAHO database shows a minimum available price of $324 per patient per year for atazanavir .
Hepatitis B Treatments
Tenofovir disoproxil fumarate (TDF) and Tenofovir alafenamide (TAF)
The above analysis shows that TDF and TAF could be manufactured for $23 and $38 per patient, per year, respectively (Appendix 4a, 5a).
International list prices for oral courses of TDF ranged from $13,204 per course in US pharmacies to $4.36 per course in Vietnam (Figure 2i). The PAHO database showed a minimum price for TDF of $39 per year . Annual prices of TAF ranged from $16,471 in the United States to $190 in India. The price of TAF in the US was slightly lower through the Veterans affairs system compared to standard pharmacy prices, at $11,052 per course (Figure 2j).
Hepatitis C Treatments
Our analysis used an 84-day, 400mg/60mg once daily course of treatment, as per FDA guidelines [46, 47]. The weighted mean API cost of the shipments for SOF and DAC in 2021 were $756/kg and $494/kg, respectively. This corresponds to an 84-day course of this combined dose at $35 per patient (Appendix 9a).
Limited international list prices for an oral combined dose of SOF/DAC ranged from $983 per course in Bangladesh to $704 in India (Figure 2k). SOF/DAC is not available for routine sale in the US.
The combined dose of SOF/VEL uses a dose of 400mg/100mg once daily, for 84 days .
The weighted average API cost of velpatasvir was $4,704/kg. After factoring in costs, an 84-day oral course could be manufactured for $48 per patient (Appendix 10a). Using this price, and the above calculated price for SOF, a combined dose production cost of SOF/VEL is estimated at $79 per patient.
International list prices for an oral combined dose of SOF/VEL ranged from $52,676 in the UK, to $565 in India (Figure 2l).