5 ms·

Sadly from the manufacturing process description alone, we are going to be decades away from when it's actually ...not a few million dollars per individual to t

Sadly from the manufacturing process description alone, we are going to be decades away from when it's actually ...not a few million dollars per individual to treat.

faitswulff 6y ago
An individually tailored cancer treatment is already available in the form of the CAR-T therapies, which might give an indication of how expensive it’ll be - you were pretty much right on the dot, since each treatment in a course of treatments is estimated at $375,000.
- iguy 6y ago
  What is this money spent on? Is it a real cost per dose, or just a made-up number for something made in a research lab? Maybe another way to ask is: On the scale from 400k of white-shoe lawyer-hours, to 400k of custom 7nm silicon-etching, where should I mentally place this? The former isn't going to budge, the latter will cost pennies in a generation's time.
  - seibelj 6y ago
    What they charge might be made up, but the costs of developing these drugs are astronomical. My wife is a cancer research scientist in immunotherapies and she can burn through tens of thousands of dollars in materials running a single experiment. And if she makes a mistake - the money is wasted!
    - iguy 6y ago
      For sure, I don't mean to suggest it's cheap research. But whether you charge a lot or nothing for the first few doses out of the lab, it seems like this won't really make a dent in the research cost. (I don't know if this $375,000 number is in that category, or not.)
    - xorfish 6y ago
      If the cost for every individual treatment is low, then the cost per treatment gets lower with more patients that can benefit from it.
  - tbenst 6y ago
    Ha! The technology itself is cheap, fabricating a bunch of de novo mRNA is only a few hundred dollars these days. I’m not sure how much volume is needed for treatment, and there’s obviously much stricter QA/QC that must happen for human use, but still the actual manufacturing part is likely no more than single digit thousands per dose. At scale, per your semiconductor analogy, could likely be brought down to single-digit dollars with time.
- rflrob 6y ago
  There’s a lot of reason to suspect that, once the pipeline is set up and validated, tailored RNA will be a lot cheaper than CAR-T. cell culture is hard, whereas ordering a gene length DNA construct is “only” a few hundred bucks[1]. From there, getting it to mRNA is relatively straightforward. Doing this all medical grade and at scale will be a huge challenge, but should be significantly easier than mass producing CAR-Ts. [1] https://www.genewiz.com/Public/Services/Gene-Synthesis/TurboGENE https://www.genewiz.com/Public/Services/Gene-Synthesis/Turbo...
- inglor_cz 6y ago
  In order to produce a personalized anti-cancer RNA vaccine, you need to a) do a biopsy of the tumor and some healthy tissue, which is fairly cheap, b) do genetic analysis of those samples to find the differences. This used to be prohibitively expensive, but now is fairly cheap too, the price went down six (!) orders of magnitude since 2000, c) ask specialized software to find the optimal protein set to express. This software can be used for all the patients around, so cost of development will be split among them, d) synthetize the correct messenger RNA and embed it in lipid nanoparticles. Not cheap, but not prohibitively expensive either, this is basically a biological equivalent of a printing job, e) check the resulting drug and send it to the clinic where the patient is treated. This all together is a much more straightforward and automatized process than extracting tumor-invading lymphocytes from a patient and babying them in vitro with a lot of attention from human scientists and use of fairly expensive reagents. The price tag for this process per se should be at least two orders of magnitude lower. Then you must add the original development and testing costs, amortized equipment cost and profit. This is where the total price tag may balloon.
  - sleepydog 6y ago
    If a parent and child develop the same cancer, is it any more likely that the same (mRNA) drug will work for both of them? Or do cancer cells mutate so much that they're unrecognizable between patients? It would have interesting implications if in the future a family could invest in a bank of mrna molecules for their future generations. A new form of wealth.
    - abiogenesis 6y ago
      I guess you should still perform steps (a), (b), and possibly (d) unless they develop it at the same time.
  - Aeolun 6y ago
    If the total course of treatment is closer to $40000 or $4000 then it doesn’t seem unreasonable for insurance to cover it.
ed25519FUUU 6y ago
If it cures late stage cancer a few million per treatment would actually be a bargain. Edit: I have no clue why people would rather something not exist than for something to exist but for it to be too expensive.
- mrmonkeyman 6y ago
  That depends on the individual..
- hobs 6y ago
  Considering that no, we dont have a few million per person than no, its not really a "bargain" unless you mean in the context of a pact with the devil.
  - maxerickson 6y ago
    Not everyone has cancer. And the price is sort of likely to come down if there is a technique that reliably treats cancer.
  - mantap 6y ago
    You can't just multiply the cost for 1 person by the number of people in the population. If it's mass produced it will be a lot cheaper. e.g. if you want to pay a chemist to synthesise Aspirin in a lab for you it will be very expensive. But it costs pennies in the store.
    - tsimionescu 6y ago
      That's only true if you can use the same aspirin as many other people. If the specific substance needs to be adjusted to your specific tumor, it may remain extremely expensive for a long time - until it becomes a technician's job to find your specific cancer signature and synthesize the drug from it.
      - abiogenesis 6y ago
        In this case "aspirin" is the equipment/software/education needed to perform this treatment; not the mRNA itself.
JoshuaDavid 6y ago
Lots of biotech-type things are rapidly getting cheaper. Most notably for this purpose, sequencing and DNA synthesis are both getting cheaper at an exponential rate (to the point that there's a term for it -- the Carlson curve -- similar to Moore's law for computing). A treatment that costs a few million dollars now will cost a few thousand dollars in a decade or two, assuming all costs scale according to the Carlson curve. In practice, this is probably a bad assumption, if nothing else because a hospital bed alone costs a thousand dollars a night or more, but it does seem likely that mRNA-based treatments will become much cheaper to develop over time to the point where they will be cheap enough to be viable by the time they would actually finish passing through the regulatory hurdles.
- jjeaff 6y ago
  Ya, I have heard virologists talking about how many can already do mrna work in their own lab. It's scaling it up that is the expensive part. But I suspect it will just be a matter of new machinery focused on individual production rather than bulk production.

Sadly from the manufacturing process description alone, we are going to be decades away from when it's actually ...not a few million dollars per individual to treat.

faitswulff 6y ago

An individually tailored cancer treatment is already available in the form of the CAR-T therapies, which might give an indication of how expensive it’ll be - you were pretty much right on the dot, since each treatment in a course of treatments is estimated at $375,000.

iguy 6y ago
What is this money spent on? Is it a real cost per dose, or just a made-up number for something made in a research lab? Maybe another way to ask is: On the scale from 400k of white-shoe lawyer-hours, to 400k of custom 7nm silicon-etching, where should I mentally place this? The former isn't going to budge, the latter will cost pennies in a generation's time.
- seibelj 6y ago
  What they charge might be made up, but the costs of developing these drugs are astronomical. My wife is a cancer research scientist in immunotherapies and she can burn through tens of thousands of dollars in materials running a single experiment. And if she makes a mistake - the money is wasted!
  - iguy 6y ago
    For sure, I don't mean to suggest it's cheap research. But whether you charge a lot or nothing for the first few doses out of the lab, it seems like this won't really make a dent in the research cost. (I don't know if this $375,000 number is in that category, or not.)
  - xorfish 6y ago
    If the cost for every individual treatment is low, then the cost per treatment gets lower with more patients that can benefit from it.
- tbenst 6y ago
  Ha! The technology itself is cheap, fabricating a bunch of de novo mRNA is only a few hundred dollars these days. I’m not sure how much volume is needed for treatment, and there’s obviously much stricter QA/QC that must happen for human use, but still the actual manufacturing part is likely no more than single digit thousands per dose. At scale, per your semiconductor analogy, could likely be brought down to single-digit dollars with time.
rflrob 6y ago
There’s a lot of reason to suspect that, once the pipeline is set up and validated, tailored RNA will be a lot cheaper than CAR-T. cell culture is hard, whereas ordering a gene length DNA construct is “only” a few hundred bucks[1]. From there, getting it to mRNA is relatively straightforward. Doing this all medical grade and at scale will be a huge challenge, but should be significantly easier than mass producing CAR-Ts. [1] https://www.genewiz.com/Public/Services/Gene-Synthesis/TurboGENE https://www.genewiz.com/Public/Services/Gene-Synthesis/Turbo...
inglor_cz 6y ago
In order to produce a personalized anti-cancer RNA vaccine, you need to a) do a biopsy of the tumor and some healthy tissue, which is fairly cheap, b) do genetic analysis of those samples to find the differences. This used to be prohibitively expensive, but now is fairly cheap too, the price went down six (!) orders of magnitude since 2000, c) ask specialized software to find the optimal protein set to express. This software can be used for all the patients around, so cost of development will be split among them, d) synthetize the correct messenger RNA and embed it in lipid nanoparticles. Not cheap, but not prohibitively expensive either, this is basically a biological equivalent of a printing job, e) check the resulting drug and send it to the clinic where the patient is treated. This all together is a much more straightforward and automatized process than extracting tumor-invading lymphocytes from a patient and babying them in vitro with a lot of attention from human scientists and use of fairly expensive reagents. The price tag for this process per se should be at least two orders of magnitude lower. Then you must add the original development and testing costs, amortized equipment cost and profit. This is where the total price tag may balloon.
- sleepydog 6y ago
  If a parent and child develop the same cancer, is it any more likely that the same (mRNA) drug will work for both of them? Or do cancer cells mutate so much that they're unrecognizable between patients? It would have interesting implications if in the future a family could invest in a bank of mrna molecules for their future generations. A new form of wealth.
  - abiogenesis 6y ago
    I guess you should still perform steps (a), (b), and possibly (d) unless they develop it at the same time.
- Aeolun 6y ago
  If the total course of treatment is closer to $40000 or $4000 then it doesn’t seem unreasonable for insurance to cover it.

ed25519FUUU 6y ago

If it cures late stage cancer a few million per treatment would actually be a bargain. Edit: I have no clue why people would rather something not exist than for something to exist but for it to be too expensive.

mrmonkeyman 6y ago
That depends on the individual..
hobs 6y ago
Considering that no, we dont have a few million per person than no, its not really a "bargain" unless you mean in the context of a pact with the devil.
- maxerickson 6y ago
  Not everyone has cancer. And the price is sort of likely to come down if there is a technique that reliably treats cancer.
- mantap 6y ago
  You can't just multiply the cost for 1 person by the number of people in the population. If it's mass produced it will be a lot cheaper. e.g. if you want to pay a chemist to synthesise Aspirin in a lab for you it will be very expensive. But it costs pennies in the store.
  - tsimionescu 6y ago
    That's only true if you can use the same aspirin as many other people. If the specific substance needs to be adjusted to your specific tumor, it may remain extremely expensive for a long time - until it becomes a technician's job to find your specific cancer signature and synthesize the drug from it.
    - abiogenesis 6y ago
      In this case "aspirin" is the equipment/software/education needed to perform this treatment; not the mRNA itself.

JoshuaDavid 6y ago

Lots of biotech-type things are rapidly getting cheaper. Most notably for this purpose, sequencing and DNA synthesis are both getting cheaper at an exponential rate (to the point that there's a term for it -- the Carlson curve -- similar to Moore's law for computing). A treatment that costs a few million dollars now will cost a few thousand dollars in a decade or two, assuming all costs scale according to the Carlson curve. In practice, this is probably a bad assumption, if nothing else because a hospital bed alone costs a thousand dollars a night or more, but it does seem likely that mRNA-based treatments will become much cheaper to develop over time to the point where they will be cheap enough to be viable by the time they would actually finish passing through the regulatory hurdles.

jjeaff 6y ago
Ya, I have heard virologists talking about how many can already do mrna work in their own lab. It's scaling it up that is the expensive part. But I suspect it will just be a matter of new machinery focused on individual production rather than bulk production.