Andy,
Thanks for pointing me towards this thread - one small correction on kelfer - Ciba-Geigy had the original discovery on L1, but chose not to proceed with the drug, citing problematic issues with the drug. I am not sure if the patent lapsed or not, but Cipla then decided to look at the drug in India, while Apotex did the same in Canada. (BTW, Cipla took it up on the request of a few members of Mumbai Thalassaemic Society, and Cipla's CEO and owner Dr Hamid put his personal weight behind the move). The first trials of Kelfer started in India in 1987, while similar trials started in Canada. Unfortunately, due to a couple of deaths (4, if I remember correctly) in Canada and fears of Kelfer causing liver toxicity and damage, the trials were halted there. Indian trials continued ..... and it was a success. Thanks to the efforts of Sion and J J Hospital, and Dr M B Agarwal among others. But, here we hit a road block - the Indian FDA would not approve the drug as it was not approved by US FDA (original molecule was american, in their view) and the stoppage of the trial in Canada.
Many of us owe a huge debt of gratitude to Ashish here, which can never be repaid - he came up with the idea of going to Delhi and lobbying the health secretary personally. He and a bunch of us did that, with surprising results. The drug was approved but could not be sold OTC but could only be sold through specified channels, and under doctor supervision. The rest, as they say, is history.
Apotex launched the drug in UK about 15 years after it was first made available in India. Canada followed suit after that. I believe US has still not approved it.
A big cost difference that you see in drugs between the US and India is the amount of money that the big pharama cos spend on marketing in the US. Advertising drugs through mass media is banned in India, as it is in many countries. While following the Lipitor trial between Pfizer and India's Ranbaxy, what struck me was that in the past 3 years, Pfizer has spent more on marketing than R&D even if you add the amortised expenses back!!
Oh well ......
Poirot
Cipla sells Kelfer at cost. Their version of Exjade will apparently also be sold at cost. Kelfer is the same drug as Ferriprox. The difference in price can be attributed to two factors. First, Cipla is selling these meds at the cost of production price. Second, and this is a huge factor, Cipla has none of the costs that Novartis or Apotex incurred in developing these drugs. To put it simply, Cipla is "stealing" patented drugs and counterfeiting them.