Curative hepatitis C virus (HCV) antiviral drugs has been a topic of controversy for the last few years, largely due to the hefty price tag that comes with the drugs.

Solvaldi and Harvoni, 2 of the most well-known hepatitis C drugs, cost $84,000 and $94,500, respectively. Despite the high list prices, there has been little exploration of the negotiated net price.

A recent analysis from the IMS Institute of Healthcare Informatics studied the net prices, Medicare Part D and government-reimbursed prices various countries paid for Sovaldi and Harvoni. Investigators also looked at the prevalence of treatment in the United States and other countries. Net prices were gathered from public disclosures and media reports, and were discovered to be similar among different countries.

Investigators found that the European Union paid $45,056 per treatment course of Sovaldi, and the United States paid $44,520. Japan paid the lowest out of the countries studied, paying $43,000.

Harvoni cost approximately $52,279 in the European Union, and cost $55,517 in Japan. Interestingly, the drug only cost $50,400 in the United States.

These net prices were approximately 15% to 20% off list prices, but the United States has seen discounts between 45% and 55%. A factor that may affect pricing is that some countries have negotiated prices based on utilization, rather than negotiating a certain price, according to the study.

Approximately 527,000 patients with HCV were treated in these countries in 2015, which reduced the population with this disease by 5.8%. The investigators also discovered that the United States had the highest treatment prevalence, with 237,000 patients treated, including 118,000 patients treated by Medicare Part D alone.

The country with the second highest treatment rate was Japan, which treated 120,000 individuals with HCV. Other countries, such as the UK and France, only treated 7000 and 17,000 patients, respectively.

These large discrepancies are a reflector of the disease rate of the population, according to the study. Only an estimated 0.3% of the UK’s population has HCV, which explains the low treatment rate.

Interestingly, the investigators discovered that Italy has the highest rate of HCV infection, but has a significantly lower treatment rate compared with other countries. Countries such as Germany and the United States have the highest rates of treatment, with Medicare Part D accounting for half of treatment volumes, according to the study.

The high prevalence of treatment, not necessarily the cost of the drugs, made the United States the highest spender on the drug. In 2015, they spent $10.9 billion on Harvoni and Sovaldi. Japan spent nearly half of that, spending $5.9 billion on the drugs in 2015.

There has been significant outrage in the United States due to restricted access for these high cost drugs, but as more effective treatment options hit the market, the prices are lowering.

In total, the United States, Japan, and 5 European Union countries spent a total of $25.7 billion on HCV treatments in 2015, according to the study. These findings suggest that many individuals with hepatitis C still have access to treatment, especially those covered by Medicare Part D.