4 ms·

Good question and I should have been more clear. The drug itself is $300,000-$500,000. It’s crazy expensive, but it’s not like a hedge fund patenting 100 year o

Good question and I should have been more clear. The drug itself is $300,000-$500,000. It’s crazy expensive, but it’s not like a hedge fund patenting 100 year old insulin or something, it’s a bespoke medication. I still think they are price gouging however. The medical care would likely add another $500,000. https://ashpublications.org/ashclinicalnews/news/3469/CAR-T-Cell-Therapies-Predicted-to-Cost-More-Than-1 https://ashpublications.org/ashclinicalnews/news/3469/CAR-T-... All in about $1,000,000 per patient. There were some drama in England about NICE not willing to put the medication on NHS formulary because of the sheer expense. Is it better to treat 1000 diabetics or one cancer patient? https://www.biopharma-reporter.com/Article/2018/09/21/Novartis-disappointed-and-surprised-by-NICE-CAR-T-call https://www.biopharma-reporter.com/Article/2018/09/21/Novart... They ultimately approved it.

MichaelZuo 4y ago
What do you estimate is a fair price?
- newyankee 4y ago
  My question would be more like, what would be needed for it to fall to 10% of its price ? Still only limited to developed world, but at least would make it more accessible
jojobas 4y ago
Well what makes the drug so expensive? Is it mostly mark-up for a high risk venture, is it actually taking 2+ man-years to formulate the drug for a particular patient, does it require already expensive components/reactants/whatever, bespoke machinery that would only produce a few doses in its lifetime, or some combination thereof?
- surfaceofthesun 4y ago
  Not responding with regard to any specific treatment, rather more generally. It’s a mixture of several things: * New/Niche Equipment * Few few commoditized inputs (e.g. lentiviral vector) * Labor Intensive * These setups look more like labs than large continuous or batch manufacturing sites * Everything requires GMP * This can mean weeks of training new personnel (even for well known manufactures) * Additional time & resources for FDA approval (safety testing, documentation, validation, This is a good reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/
- deleted 4y ago
  [deleted]
ETH_start 4y ago
We need to massively scale back regulatory regimentation in medicine "FDA Deregulation Increases Safety and Innovation and Reduces Prices" https://marginalrevolution.com/marginalrevolution/2022/11/fda-deregulation-increases-safety-and-innovation-and-reduces-prices.html https://marginalrevolution.com/marginalrevolution/2022/11/fd... We will never get the pace of innovation and price reduction in medicine that we see in more market based product classes if we don't.
- electriclove 4y ago
  Seriously, innovation needs to be encouraged and all the gates hamper that. But being critical of the medical cartel gets flagged/downvoted quickly here. See comment higher up.
- yosame 4y ago
  It might reduce prices, but I wouldn't trust pharma companies to put safety over profit. We've seen time and time again that pharma companies will do the bare minimum to prove safety, which has lead to a large amount of harm (see Vioxx, Thalidomide, etc). I don't think reducing what safety measures they have to prove will make therapies safer.
  - ETH_start 4y ago
    The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. In any case it's obvious to me at least that in the long run, if medicine sees the same pace of innovation that, say, smartphones have seen, or even that the cosmetic surgery field has seen, we would have much safer medical products and services just by virtue of them being significantly more sophisticated, less invasive etc. Finally - even if all this weren't true - without price reductions, it will be increasingly the case that the safest and most effective treatments will be out of reach of the masses, due to simple economics/scarcity. I would rather have some lower quality products/services available to the public, and the best quality ones be more accessible, than remove the lower quality offerings but also deprive the public of the best quality ones.
wanderingmoose 4y ago
To put this in perspective, a family member was treated for leukemia and our billed* medical expenses hit $300,000 in the first 2 weeks of treatment. This included the initial hospitalization, attempted install of PIC line, install of broviac catheer. And secondary hospitalization in hepa controlled room due to other illness during an immuno compromised period. The standard treatment continues for ~2.5 years so this was only a small portion of the bills we received. *obviously what is paid by insurance + out of pocket is very different, but that level of billing is insane. Also you really don't want to be fighting insurance and the medical center over billing while your family is undergoing cancer treatment. This was at UCLA
DanBC 4y ago
Part of the NICE discussions is to apply pressure to get a lower price. I feel like this is a good thing to prevent gouging. The second version of the Cancer Drugs Fund is also useful here, because it makes available stuff that isn't in the BNF. The draft guidance is here: https://www.nice.org.uk/guidance/ta567/documents/appraisal-consultation-document https://www.nice.org.uk/guidance/ta567/documents/appraisal-c... It's long and detailed and it'd be unfair of me to pull anything out specifically.

MichaelZuo 4y ago

What do you estimate is a fair price?

newyankee 4y ago
My question would be more like, what would be needed for it to fall to 10% of its price ? Still only limited to developed world, but at least would make it more accessible

jojobas 4y ago

Well what makes the drug so expensive? Is it mostly mark-up for a high risk venture, is it actually taking 2+ man-years to formulate the drug for a particular patient, does it require already expensive components/reactants/whatever, bespoke machinery that would only produce a few doses in its lifetime, or some combination thereof?

surfaceofthesun 4y ago
Not responding with regard to any specific treatment, rather more generally. It’s a mixture of several things: * New/Niche Equipment * Few few commoditized inputs (e.g. lentiviral vector) * Labor Intensive * These setups look more like labs than large continuous or batch manufacturing sites * Everything requires GMP * This can mean weeks of training new personnel (even for well known manufactures) * Additional time & resources for FDA approval (safety testing, documentation, validation, This is a good reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/
deleted 4y ago
[deleted]

ETH_start 4y ago

We need to massively scale back regulatory regimentation in medicine "FDA Deregulation Increases Safety and Innovation and Reduces Prices" https://marginalrevolution.com/marginalrevolution/2022/11/fda-deregulation-increases-safety-and-innovation-and-reduces-prices.html https://marginalrevolution.com/marginalrevolution/2022/11/fd... We will never get the pace of innovation and price reduction in medicine that we see in more market based product classes if we don't.

electriclove 4y ago
Seriously, innovation needs to be encouraged and all the gates hamper that. But being critical of the medical cartel gets flagged/downvoted quickly here. See comment higher up.
yosame 4y ago
It might reduce prices, but I wouldn't trust pharma companies to put safety over profit. We've seen time and time again that pharma companies will do the bare minimum to prove safety, which has lead to a large amount of harm (see Vioxx, Thalidomide, etc). I don't think reducing what safety measures they have to prove will make therapies safer.
- ETH_start 4y ago
  The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. In any case it's obvious to me at least that in the long run, if medicine sees the same pace of innovation that, say, smartphones have seen, or even that the cosmetic surgery field has seen, we would have much safer medical products and services just by virtue of them being significantly more sophisticated, less invasive etc. Finally - even if all this weren't true - without price reductions, it will be increasingly the case that the safest and most effective treatments will be out of reach of the masses, due to simple economics/scarcity. I would rather have some lower quality products/services available to the public, and the best quality ones be more accessible, than remove the lower quality offerings but also deprive the public of the best quality ones.

wanderingmoose 4y ago

To put this in perspective, a family member was treated for leukemia and our billed* medical expenses hit $300,000 in the first 2 weeks of treatment. This included the initial hospitalization, attempted install of PIC line, install of broviac catheer. And secondary hospitalization in hepa controlled room due to other illness during an immuno compromised period. The standard treatment continues for ~2.5 years so this was only a small portion of the bills we received. *obviously what is paid by insurance + out of pocket is very different, but that level of billing is insane. Also you really don't want to be fighting insurance and the medical center over billing while your family is undergoing cancer treatment. This was at UCLA

DanBC 4y ago

Part of the NICE discussions is to apply pressure to get a lower price. I feel like this is a good thing to prevent gouging. The second version of the Cancer Drugs Fund is also useful here, because it makes available stuff that isn't in the BNF. The draft guidance is here: https://www.nice.org.uk/guidance/ta567/documents/appraisal-consultation-document https://www.nice.org.uk/guidance/ta567/documents/appraisal-c... It's long and detailed and it'd be unfair of me to pull anything out specifically.