11 ms·

> Vertex set the price of Casgevy at $2.2 million > Patients must spend weeks, even months, in the hospital before and after the therapy is administered. Yoik

by SamBam 3y ago

> Vertex set the price of Casgevy at $2.2 million > Patients must spend weeks, even months, in the hospital before and after the therapy is administered. Yoiks. So how many actual people are going to be able to get this treatment?

coldpie 3y ago
Indeed. The good news is, it actually turns out to be about the same or cheaper than ongoing treatment of a untreated sickle cell: """Each treatment is an individualized “one-off” treatment. For this reason, a single treatment for a single patient is expensive. At present it is estimated that in the UK treatment will cost £1 million or more. In the US the estimated cost is $2 million. That may seem prohibitive, but we need to consider the overall cost-effectiveness of the treatment, which means comparing the cost of treatment to the cost of managing each disease without the treatment. Sickle cell patient require frequent hospitalization, which can be very expensive. One analysis found that Casgevy can be cost effective at £1.5 million or $1.9 million. This is in range of the estimated cost. Also, the longer the treatment benefits last, the more cost effective the treatment becomes. A lifetime of transfusions or hospital admissions adds up.""" https://sciencebasedmedicine.org/first-crispr-treatment-approval/ https://sciencebasedmedicine.org/first-crispr-treatment-appr...
- BurningFrog 3y ago
  Not quite true: Identical twins/triplets/etc, can reuse the same cure.
- thereisnospork 3y ago
  > it actually turns out to be about the same or cheaper than ongoing treatment of a untreated sickle cell If I were a betting man I'd wager the house that the above is exactly why it costs what it does. 'Pay 2 million now, or pay 2 million over the rest of the patient's life as they suffer' is a pretty inarguable value proposition. Of course once patents expire and processes refine prices will come down. The wheel of progress rolls on (more of less) as intended.
ericmay 3y ago
This is Day 1 so the price and how well it works today is almost certainly the worst it will ever be. Insurance will likely cover the cost. It's a very bad, painful, and outright deadly genetic mutation and $2.2 million is practically nothing compared to doubling someone's lifespan or giving them an extra 10 years. More info I found relevant regarding cost for typical treatment and out of pocket estimated costs: https://www.hematology.org/newsroom/press-releases/2022/the-cost-of-living-with-sickle-cell-disease https://www.hematology.org/newsroom/press-releases/2022/the-...
- ponector 3y ago
  I don't agree that it is nothing. 2 millions, if applied properly, could do good for many people. Take ten children from poverty, give ten children chance to get a good education, etc. There is always a some kind of moral dilemma: should you spent millions to try to extend extremely I'll person or help with that money to some healthy poor children?
  - dopa42365 3y ago
    It's possible to do both :)
    - lotsofpulp 3y ago
      How? Society does not have unlimited resources. Especially the one that extremely ill people need, humans.
      - huytersd 3y ago
        People with sickle cell already cost the taxpayer a lot of money over their lifetimes. I wouldn’t be surprised if it cost more than this treatment.
        lotsofpulp 3y ago
        Of course, in that case it is simple. I imagine dopa42365 was referring to a scenario where there was an alternative way to spend the money.
jimbob45 3y ago
The Hep C cure was 100k USD when it released in 2014. 10 years later, it’s 25k USD max before insurance. The price you see now will likely shrink in the coming years. Pretty good opportunity for an analysis on CRISPR pricing if you have a well-trafficked blog and are willing to track this for the next five years.
- biomcgary 3y ago
  And much better than a liver transplant.
  - chimeracoder 3y ago
    > And much better than a liver transplant. There are a lot of steps in between "acute HCV infection" and "requiring a liver transplant", and many insurers, even today, will require you to go through some or all of them before considering paying for HCV antivirals.
- chimeracoder 3y ago
  > The Hep C cure was 100k USD when it released in 2014. 10 years later, it’s 25k USD max before insurance. That's not a great comparison. There was a previous cure for hepatitis C before the first antiviral-based cure 2013, and the initial treatment regiment for the antiviral based regimen was a hybrid of the two, before they settled on a fully antiviral-based treatment. The reason that the antivirals came down in price so quickly was because so many nearly-identical ones came on the market within a couple of years. That's due to the discovery of a particular protein and corresponding class of inhibitors some years earlier, which was not patented, opening the door for a flood of drugs which are all functionally identical in purpose and mechanism of action, but chemically distinct and eligible for separate patent protections. That came at a time when political and other pressures made some private insurers more willing to approve treatment (usually after a few rounds of denials and appeals) - but again, with an emphasis on some, because there are large classes of people for whom it is difficult or impossible to get treated for HCV today. (They're just not the ones likely to comment on HN). Contrast to this treatment, which is for a congenital condition that does not have the same political pressure to address, and for which a significant financial barrier to access is not merely the costs of the drug, but the cost of the associated care (chemotherapy, etc.) which is not included in the quoted price. In addition the patent laws function differently in this case, to the detriment of patients. The history of hepatitis C and its treatment is fairly idiosyncratic and it would be a mistake to use the price trajectory of HCV antivirals as a predictor for any other treatment.
ajross 3y ago
Collectively paying for rare but expensive treatments is literally the problem that insurance solves. This isn't wildly out of the expected range for this sort of thing. And it will surely get cheaper as it evolves.
- lotsofpulp 3y ago
  Since the collective probability of rare, but expensive health issues is basically 100%, I would describe it less as insurance and more as wealth redistribution. Hence the (typical) requirement to purchase insurance and lack of ability to price it based on risk. Of course, insurance and taxation can be viewed as similar things anyway, but it is different from things like term life insurance or motor vehicle insurance or home owners insurance.
  - soulbadguy 3y ago
    > Since the collective probability of rare, but expensive health issues is basically 100%, I would describe it less as insurance and more as wealth redistribution. Humm no... It's just risk amortization...
    - lotsofpulp 3y ago
      If it was just that (in the US), then there would be no need to prevent insurers from pricing based on health of the insured. Or legislating a 3x cap on premiums between highest and lowest premium. Or legislating out of pocket maximums. The premiums are very explicitly a subsidy from young to old, which I view as a tax by a different name. Except instead of it being based on one’s income/wealth, it is based on age.
      - BurningFrog 3y ago
        What we in the US call "health insurance" is today very different from the textbook definition of insurance.
        3y ago
hanniabu 3y ago
I'm assuming they're setting the price so high since insurance will only approve payment of a fraction of that
seydor 3y ago
i always find those prices unbelievable. What is the actual cost of all the expense and workhours for making the treatment
- quickthrower2 3y ago
  Throw that stone in the SaaS glass house. $100/m for 10c of compute and $1 of a devs time.
refurb 3y ago
Sure. It's pretty typical for sickle cell patients to have to go to the hospital severe times per year for "sickle cell crisis". If this is a cure (I haven't looked at the data), imagine the NPV of a lifetime of multiple hospitalizations per year. It's likely in the millions.
ufmace 3y ago
That's how technological progress works. The first version is expensive and not very good, so it isn't used much. But some use proves that it works, lets the kinks get worked out, and gives the makers funding and incentive to optimize the cost and quality. Give them time for a few iterations and it'll be cheap and plentiful. Just like the iPhone - the first one was super expensive, harder to get, and pretty limited. Now there's lots of cheap options and they're everywhere.

by SamBam 3y ago

coldpie 3y ago

Indeed. The good news is, it actually turns out to be about the same or cheaper than ongoing treatment of a untreated sickle cell: """Each treatment is an individualized “one-off” treatment. For this reason, a single treatment for a single patient is expensive. At present it is estimated that in the UK treatment will cost £1 million or more. In the US the estimated cost is $2 million. That may seem prohibitive, but we need to consider the overall cost-effectiveness of the treatment, which means comparing the cost of treatment to the cost of managing each disease without the treatment. Sickle cell patient require frequent hospitalization, which can be very expensive. One analysis found that Casgevy can be cost effective at £1.5 million or $1.9 million. This is in range of the estimated cost. Also, the longer the treatment benefits last, the more cost effective the treatment becomes. A lifetime of transfusions or hospital admissions adds up.""" https://sciencebasedmedicine.org/first-crispr-treatment-approval/ https://sciencebasedmedicine.org/first-crispr-treatment-appr...

BurningFrog 3y ago
Not quite true: Identical twins/triplets/etc, can reuse the same cure.
thereisnospork 3y ago
> it actually turns out to be about the same or cheaper than ongoing treatment of a untreated sickle cell If I were a betting man I'd wager the house that the above is exactly why it costs what it does. 'Pay 2 million now, or pay 2 million over the rest of the patient's life as they suffer' is a pretty inarguable value proposition. Of course once patents expire and processes refine prices will come down. The wheel of progress rolls on (more of less) as intended.

ericmay 3y ago

This is Day 1 so the price and how well it works today is almost certainly the worst it will ever be. Insurance will likely cover the cost. It's a very bad, painful, and outright deadly genetic mutation and $2.2 million is practically nothing compared to doubling someone's lifespan or giving them an extra 10 years. More info I found relevant regarding cost for typical treatment and out of pocket estimated costs: https://www.hematology.org/newsroom/press-releases/2022/the-cost-of-living-with-sickle-cell-disease https://www.hematology.org/newsroom/press-releases/2022/the-...

ponector 3y ago
I don't agree that it is nothing. 2 millions, if applied properly, could do good for many people. Take ten children from poverty, give ten children chance to get a good education, etc. There is always a some kind of moral dilemma: should you spent millions to try to extend extremely I'll person or help with that money to some healthy poor children?
- dopa42365 3y ago
  It's possible to do both :)
  - lotsofpulp 3y ago
    How? Society does not have unlimited resources. Especially the one that extremely ill people need, humans.
    - huytersd 3y ago
      People with sickle cell already cost the taxpayer a lot of money over their lifetimes. I wouldn’t be surprised if it cost more than this treatment.
      - lotsofpulp 3y ago
        Of course, in that case it is simple. I imagine dopa42365 was referring to a scenario where there was an alternative way to spend the money.

jimbob45 3y ago

The Hep C cure was 100k USD when it released in 2014. 10 years later, it’s 25k USD max before insurance. The price you see now will likely shrink in the coming years. Pretty good opportunity for an analysis on CRISPR pricing if you have a well-trafficked blog and are willing to track this for the next five years.

biomcgary 3y ago
And much better than a liver transplant.
- chimeracoder 3y ago
  > And much better than a liver transplant. There are a lot of steps in between "acute HCV infection" and "requiring a liver transplant", and many insurers, even today, will require you to go through some or all of them before considering paying for HCV antivirals.
chimeracoder 3y ago
> The Hep C cure was 100k USD when it released in 2014. 10 years later, it’s 25k USD max before insurance. That's not a great comparison. There was a previous cure for hepatitis C before the first antiviral-based cure 2013, and the initial treatment regiment for the antiviral based regimen was a hybrid of the two, before they settled on a fully antiviral-based treatment. The reason that the antivirals came down in price so quickly was because so many nearly-identical ones came on the market within a couple of years. That's due to the discovery of a particular protein and corresponding class of inhibitors some years earlier, which was not patented, opening the door for a flood of drugs which are all functionally identical in purpose and mechanism of action, but chemically distinct and eligible for separate patent protections. That came at a time when political and other pressures made some private insurers more willing to approve treatment (usually after a few rounds of denials and appeals) - but again, with an emphasis on some, because there are large classes of people for whom it is difficult or impossible to get treated for HCV today. (They're just not the ones likely to comment on HN). Contrast to this treatment, which is for a congenital condition that does not have the same political pressure to address, and for which a significant financial barrier to access is not merely the costs of the drug, but the cost of the associated care (chemotherapy, etc.) which is not included in the quoted price. In addition the patent laws function differently in this case, to the detriment of patients. The history of hepatitis C and its treatment is fairly idiosyncratic and it would be a mistake to use the price trajectory of HCV antivirals as a predictor for any other treatment.

ajross 3y ago

Collectively paying for rare but expensive treatments is literally the problem that insurance solves. This isn't wildly out of the expected range for this sort of thing. And it will surely get cheaper as it evolves.

lotsofpulp 3y ago
Since the collective probability of rare, but expensive health issues is basically 100%, I would describe it less as insurance and more as wealth redistribution. Hence the (typical) requirement to purchase insurance and lack of ability to price it based on risk. Of course, insurance and taxation can be viewed as similar things anyway, but it is different from things like term life insurance or motor vehicle insurance or home owners insurance.
- soulbadguy 3y ago
  > Since the collective probability of rare, but expensive health issues is basically 100%, I would describe it less as insurance and more as wealth redistribution. Humm no... It's just risk amortization...
  - lotsofpulp 3y ago
    If it was just that (in the US), then there would be no need to prevent insurers from pricing based on health of the insured. Or legislating a 3x cap on premiums between highest and lowest premium. Or legislating out of pocket maximums. The premiums are very explicitly a subsidy from young to old, which I view as a tax by a different name. Except instead of it being based on one’s income/wealth, it is based on age.
    - BurningFrog 3y ago
      What we in the US call "health insurance" is today very different from the textbook definition of insurance.
      - 3y ago

hanniabu 3y ago

I'm assuming they're setting the price so high since insurance will only approve payment of a fraction of that

seydor 3y ago

i always find those prices unbelievable. What is the actual cost of all the expense and workhours for making the treatment

quickthrower2 3y ago
Throw that stone in the SaaS glass house. $100/m for 10c of compute and $1 of a devs time.

refurb 3y ago

Sure. It's pretty typical for sickle cell patients to have to go to the hospital severe times per year for "sickle cell crisis". If this is a cure (I haven't looked at the data), imagine the NPV of a lifetime of multiple hospitalizations per year. It's likely in the millions.

ufmace 3y ago

That's how technological progress works. The first version is expensive and not very good, so it isn't used much. But some use proves that it works, lets the kinks get worked out, and gives the makers funding and incentive to optimize the cost and quality. Give them time for a few iterations and it'll be cheap and plentiful. Just like the iPhone - the first one was super expensive, harder to get, and pretty limited. Now there's lots of cheap options and they're everywhere.