6 ms·

They're priced this way because they're 80-90% cheaper than the previous treatment. Previously, with no cure, HepC patients would have eventually had a liver t

by trimbo 7y ago

They're priced this way because they're 80-90% cheaper than the previous treatment. Previously, with no cure, HepC patients would have eventually had a liver transplant. Liver transplants cost between $500K-$1M. Of course, it also requires a liver, so many would die waiting for a liver. As you noted, the drugs have become much cheaper. Mavyret is ~1/2 the cost of Sovaldi, the first drug on the market (replaced by Harvoni). Mavyret actually only has an 8 week treatment, which is an improvement over the 12 weeks of Harvoni. The competition within these drugs became so fierce that, despite these prices, no new ones are planned (last I read). In fact, one you listed here has been off the market for over a year https://www.empr.com/home/news/two-hepatitis-c-virus-infection-treatments-to-be-discontinued/ https://www.empr.com/home/news/two-hepatitis-c-virus-infecti...

deith 7y ago
Pro-tip: it doesn't actually cost $500K-1M to transplant a liver (which you get for free).
- pc86 7y ago
  Do you have a source for this?
  - dajohnson89 7y ago
    I think he means we're all born with a liver. And transplanting your liver is a matter of walking.
- 0xB31B1B 7y ago
  It costs an insane amount of money. 1) there is a large infrastructure around organ donations that needs to be maintained 2) it generally requires the organ (and some times doctor) to be flown on a private jet from where the organ comes from to the person receiving the transplant 3) transplant surgery is a very long procedure requiring multiple specialists 4) recipient is on a lifelong course of drugs (literally like a handful of expensive drugs every day) that suppresses their immune system so the body doesn’t reject the organ Source: wife is a doctor at research hospital
  - pagutierrezn 7y ago
    I'm a little bit surprised about these comments. One of my friends is a doctor at a Hospital in Bilbao with 30 years of experience. He tells me that this is the first year he has seen livers availabe for transplant that were not transplanted because no patient needed them. His argument is that more and more hepatitis C patients are receiving the antivirals and do not need a transplant anymore. May be someone has data from other European countries with a strong public health sector
phkahler 7y ago
>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already making the threat for them. I was about to summarize by saying "sometimes a free market can mimick evil" but I just remembered it's not a free market at all. These treatments have government granted monopoly status via patents. That's why they are priced so high.
- HarryHirsch 7y ago
  With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capital. Wilson's disease is treated with triethylenetetramine. The price had always been ~ USD 600 for 100 pills until the manufacturer became bought out by Valeant, who then raised it to 20 kUSD for 100 pills. There was the usual protestations by Hillary Clinton and other politicians, but the price is still where it is. Where is the revolution?
  - ouid 7y ago
    Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.
    - HarryHirsch 7y ago
      The early research is done on federal grants. What costs real money is late-stage development and especially clinical research, startups and universities are not at all equipped for that. The financing model is problematic. Return on investment is much higher and faster in IT, besides there is a mismatch between what the market favours and where future clinical needs are (the antibiotic crisis, neglected tropical diseases).
inasio 7y ago
I used to do research on HCV. HCV was curable for at least 10 years prior to Sovaldi, the issue was that the Ribavarin and peg-interferon treatment typically took 48 weeks, had a cure rate around 50% at best if you had the right HCV genotype, and had many adverse effects. The epidemic is currently being driven (at least in western countries) by active drug users, treating them with that regime was simply not possible. Contrast that with 8 weeks or less of 1 pill per day (and possibly less), with no side effects, pangenotypic and >95% efficacy for all (including cirrhotic individuals, HIV co-infected, etc)
- refurb 7y ago
  The adverse effects for interferon were brutal. It has a boxed warning about suicide. I’ve talked to people who took it and it was like having the flu for months.
chimeracoder 7y ago
That's not true. A third of infected people spontaneously clear the virus (no chronic infection develops), and before antivirals, interferon-based treatment could cure about 50% of patients. Interferon wasn't fun - it's literally cancer treatment and has similar side effects to chemotherapy, but it's not true that people would necessarily need a liver transplant eventually.

by trimbo 7y ago

deith 7y ago

Pro-tip: it doesn't actually cost $500K-1M to transplant a liver (which you get for free).

pc86 7y ago
Do you have a source for this?
- dajohnson89 7y ago
  I think he means we're all born with a liver. And transplanting your liver is a matter of walking.
0xB31B1B 7y ago
It costs an insane amount of money. 1) there is a large infrastructure around organ donations that needs to be maintained 2) it generally requires the organ (and some times doctor) to be flown on a private jet from where the organ comes from to the person receiving the transplant 3) transplant surgery is a very long procedure requiring multiple specialists 4) recipient is on a lifelong course of drugs (literally like a handful of expensive drugs every day) that suppresses their immune system so the body doesn’t reject the organ Source: wife is a doctor at research hospital
- pagutierrezn 7y ago
  I'm a little bit surprised about these comments. One of my friends is a doctor at a Hospital in Bilbao with 30 years of experience. He tells me that this is the first year he has seen livers availabe for transplant that were not transplanted because no patient needed them. His argument is that more and more hepatitis C patients are receiving the antivirals and do not need a transplant anymore. May be someone has data from other European countries with a strong public health sector

phkahler 7y ago

>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already making the threat for them. I was about to summarize by saying "sometimes a free market can mimick evil" but I just remembered it's not a free market at all. These treatments have government granted monopoly status via patents. That's why they are priced so high.

HarryHirsch 7y ago
With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capital. Wilson's disease is treated with triethylenetetramine. The price had always been ~ USD 600 for 100 pills until the manufacturer became bought out by Valeant, who then raised it to 20 kUSD for 100 pills. There was the usual protestations by Hillary Clinton and other politicians, but the price is still where it is. Where is the revolution?
- ouid 7y ago
  Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.
  - HarryHirsch 7y ago
    The early research is done on federal grants. What costs real money is late-stage development and especially clinical research, startups and universities are not at all equipped for that. The financing model is problematic. Return on investment is much higher and faster in IT, besides there is a mismatch between what the market favours and where future clinical needs are (the antibiotic crisis, neglected tropical diseases).

inasio 7y ago

I used to do research on HCV. HCV was curable for at least 10 years prior to Sovaldi, the issue was that the Ribavarin and peg-interferon treatment typically took 48 weeks, had a cure rate around 50% at best if you had the right HCV genotype, and had many adverse effects. The epidemic is currently being driven (at least in western countries) by active drug users, treating them with that regime was simply not possible. Contrast that with 8 weeks or less of 1 pill per day (and possibly less), with no side effects, pangenotypic and >95% efficacy for all (including cirrhotic individuals, HIV co-infected, etc)

refurb 7y ago
The adverse effects for interferon were brutal. It has a boxed warning about suicide. I’ve talked to people who took it and it was like having the flu for months.

chimeracoder 7y ago

That's not true. A third of infected people spontaneously clear the virus (no chronic infection develops), and before antivirals, interferon-based treatment could cure about 50% of patients. Interferon wasn't fun - it's literally cancer treatment and has similar side effects to chemotherapy, but it's not true that people would necessarily need a liver transplant eventually.