6 ms·
From wikipedia: > When blinatumomab was approved, Amgen announced that the price for the drug would be US$178,000 per year, which made it the most expensive ca
by Traubenfuchs 3y ago
From wikipedia:
> When blinatumomab was approved, Amgen announced that the price for the drug would be US$178,000 per year, which made it the most expensive cancer drug on the market. Merck's pembrolizumab was priced at US$150,000 per year when it launched (in September 2014).[14] At the time of initial approval, only about 1,000 patients in the US had an indication for blinatumomab.
I take it they prefer to pump chemotherapy poison ito patients for financial reasons?
- ceejayoz 3y agoIt'll be substantially cheaper in the UK.
- teamonkey 3y agoFor those who need it will be free - but not to the health service, who do have to pay the sticker price.
- ben_w 3y agoNHS is approximately a monopsony, which probably has some advantages for price negotiation.
- teamonkey 3y agoA family member has had immunotherapy on the NHS and it was disclosed to them (not sure how reliable or accurate this is) that a single dose cost the NHS 4 figures. It needed several layers of approval for it to be administered.
- ben_w 3y agoFor one of the same drugs discussed above by Traubenfuchs? If so, unless I've misread the discussion, that looks like 12-140 times cheaper depending on which drug and exactly where in the 1000-9999 GPB it was?
- wlesieutre 3y agoPrices in earlier comment are per year, prices the NHS paid were per dose. Do we know how many doses per year?
- ben_w 3y agoThanks! That means I did misread.
- teamonkey 3y agoIndeed it was per dose, and IIRC the figure was over £5000. It wasn’t intended to be public knowledge, I don’t think the patient was supposed to be shown it. The various supporting chemos ranged from below £100 to about £250/dose IIRC. I mention it because in the UK people don’t really understand that drugs can be really expensive. The assumption is that due to the scale of the NHS they’re heavily discounted or even free, and that the high prices mentioned by US folk is due to the unusual healthcare situation there. But there’s real money being paid by taxes, as well as procedures that determine whether you’re worth the expenditure.
- ben_w 3y agoI'm sure some (many) make that kind of mistake, so it is worth pointing out. But also: > and that the high prices mentioned by US folk is due to the unusual healthcare situation there. Are they wrong? I keep hearing that the US government spends more per person on healthcare than the UK government, even though the US also has mostly private insurance on top of that and the UK mostly doesn't?
- teamonkey 3y agoNot wrong at all. The NHS probably does barter discounts. But consider that a discount of 50% off $150k/yr would be incredible, yet still be a vast amount of money for a single treatment.
- razakel 3y ago>It wasn’t intended to be public knowledge The price the NHS pays for drugs is published in the BNF.
- mft_ 3y agoI understand your cynicism, but let’s inject some actual data. The price that the manufacturer charges for a course of blinatumomab (in a different indication for adults, not that this is especially relevant in this discussion) is ~£56k [0] - so significantly lower than the price quoted from the US. NICE (the organisation which published the document referenced) exists to achieve value for money for the NHS for higher-priced and specialist treatments. If, following a thorough assessment, a medicine does not achieve the required value for money standard at the price proposed by the manufacturer, they are presented with two options: to not have the drug reimbursed in the UK at all, or to lower the effective price, so that the drug becomes cost-effective. [0] https://www.nice.org.uk/guidance/ta589/documents/final-appra https://www.nice.org.uk/guidance/ta589/documents/final-appra...
- AnthonyMouse 3y ago> If, following a thorough assessment, a medicine does not achieve the required value for money standard at the price proposed by the manufacturer, they are presented with two options: to not have the drug reimbursed in the UK at all, or to lower the effective price, so that the drug becomes cost-effective. Which is effectively price controls, because the number of people with the money to pay out of pocket will be low, so the choice is essentially to sell at the regulated price or not at all. And the company would be crazy to choose the latter because the high cost is to pay for R&D, not manufacturing, so they'll never be better off to abandon the market than to take whatever they're offered. Then you have prices being set by the political system. If the regulators get captured by pharma companies (as would be likely if implemented in the US) they'd overpay when the drug isn't worth it. If not, the regulators would have all the leverage and very little reason not to set prices too low, reducing the incentive for R&D and causing more people to die.
- pfdietz 3y agoThey have a disincentive to sell to other countries at a discount if those countries allow medical tourism from the US. They don't want US patients taking advantage of the lower cost there.
- ceejayoz 3y agoSticker price varies by country, and national health systems can negotiate those prices with quite a bit of market power. https://www.pgpf.org/blog/2022/11/how-much-does-the-united-states-spend-on-prescription-drugs-compared-to-other-countries https://www.pgpf.org/blog/2022/11/how-much-does-the-united-s... > According to a 2021 study by the RAND Corporation, a non-profit global policy think tank, prices of prescription drugs in the U.S. are 2.4 times higher than the average prices of nine other nations (Austria, Australia, Belgium, Canada, Germany, Japan, Sweden, Switzerland and the United Kingdom). That higher cost is largely related to brand-name drugs, which are 4.9 times more expensive in the U.S. than in those countries. In fact, brand-name drugs are responsible for 84 percent of total drug costs in the United States despite accounting for only 8 percent of drugs dispensed. The US is just starting to negotiate pricing, beginning with ten specific drugs. Until 2022, it was illegal for Medicare to do so. https://www.hhs.gov/about/news/2023/10/03/biden-harris-administration-moves-medicare-drug-price-negotiations-lower-prescription-drug-costs-people-medicare.html https://www.hhs.gov/about/news/2023/10/03/biden-harris-admin...
- teamonkey 3y agoLiterally, yes. On the NHS, they will exhaust cheaper solutions that have a fair probability of working before trying more expensive ones. Age, long term prognosis, whether they have dependents, and some other factors are also considered.
- Traubenfuchs 3y ago> dependants You mean ones life is valued more if one has children?
- teamonkey 3y agoIf you have young children that depend on you, yes.
- copperx 3y agoDo they look up records? Is this ethical? Does this also happen in the US or other countries?
- teamonkey 3y agoIt’s the UK, they have the medical history. They also ask the patient about their situation. And I made it sound mechanical, but AI has not taken over all decisions like this yet. I believe it’s a discussion between a team of doctors where they are considering the humanity and ethics of the situation as well as the cost. Like, what would be the impact on the child/dependent if the parent was to die, do they have another parent or family members they can live with, can they fend for themselves, etc.
- dekhn 3y agoThere's an entire subfield dedicated to calculating life values for making difficult decisions. https://en.wikipedia.org/wiki/Value_of_life https://en.wikipedia.org/wiki/Value_of_life I don't recall seeing having children as a variable in that valuation, it's typically more about how many years of work you continue to do, cast back into current dollars ("present value lifetime earnings", see https://escholarship.org/content/qt82d0550k/qt82d0550k.pdf?t=li5h7t https://escholarship.org/content/qt82d0550k/qt82d0550k.pdf?t...) and normalized for base rates.
- andy_xor_andrew 3y agodumb question... is it purely the demand that makes it this expensive? The "you need this or you die" aspect? Or is the cost of research and manufacturing for this stuff so astronomical that it warrants such a high price? I almost don't want to even know... if I find out it costs only ~$5 to develop a dose, and they're charging $200k to dying people... ugh
- seventytwo 3y agoThe research, development, approval process, and production all absolutely cost money that needs to be recouped from the sale, but we shouldn’t ever forget the reason why the company exists: to make profit.
- wahnfrieden 3y agoIn other words, no it is not only supply and demand - it’s the desire to maximize profit as far as the market will bear
- daedrdev 3y agoOr like the other response to your parent comment said, it could cost a ton to make, which lowers the number of people who can get it, driving costs even higher due to low volume.
- seventytwo 3y agoIt’s both. But it’s ultimately the profit motive that drives a business at all.
- konschubert 3y agoYou also need to pay for all the other research projects that did NOT yield a successful drug.
- throwup238 3y agoThere is zero chance it costs $5 per dose because blinatumomab is a bi-specific T cell engager which is a monoclonal antibody made by extracting it from a cloned white blood cell created from recombinant DNA. The yield for this process is extremely low and it's really complicated in the best of times. The cost of the pipette tips and other consumables used by the lab automation alone probably costs more. The flip side is that it treats a rare form of leukemia so the market isn't very big and since they can't lower the price enough to compete with chemo, they have to actually charge more to get their money back. For example chemo might cost $10k, but their drug costs $10k to make per person so if they charged $50k they might not even get enough customers to break even. So instead they charge $200k to get the most from the patients they can capture like the X% of patients who are allergic to the chemo drugs and have no choice (Just an example, I don't know the specifics for blinatumomab)
- anatnom 3y agoI took blinatumomab in 2015 (in my late 20s). It literally saved my life. However, the risks of blinatumomab were seen as much riskier than chemotherapy. Most notably, blinatumomab has a significant risk of triggering a cytokine storm[0], a frequently-fatal immune reaction cascade. When starting a cycle of blinatumomab, the hospital required that I be inpatient for 7 days and they checked my vitals at least once every two hours. (This was _miserable_ for my sleep schedule, which is already a mess when in the hospital.) My regimen was 7 days in the hospital, then 21 days at home constantly connected to the pump, then 7 days of recovery time before starting another cycle. At the time I took blinatumomab, I had already had unsuccessful treatments with two different chemo regimens. At the hospital system I was at, at least one failed chemo regimen was a pre-requisite for blinatumomab, as it was only indicated for "refractory" or "recurrent" cancers. I assume this is more related to the chance of acute death and (at the time) relative newness of blinatumomab compared to established chemotherapy regimens. (B-cell ALL is sadly very common in children, but this fortunately means that there is a LOT of funding research into the disease.) After going through 3 one-month cycles of blinatumomab, it was becoming less effective, but I was able to line up a allogenic stem cell transplant which has (knock on a thousand woods) kept me clean for the 8 years since. [0] https://en.wikipedia.org/wiki/Cytokine_storm https://en.wikipedia.org/wiki/Cytokine_storm
- pama 3y agoAmazing story. Thanks for sharing. For all of us who work in drug discovery the hope is to hear cases like yours become more common and hopefully one day we can push cancer out of the range of common causes of death. There is still a ton of work to do.
- Traubenfuchs 3y agoI read up on it. In the case of blinatumomab, it is called Cytokine release syndrome (CRS), it's very rare to have a high grade (dangerous, life threatening) CRS and seems to be survivable and treatable in the vast majority of those rare cases. In this review, it seems like only 2% of 189 blinatumomab patients got a grade 3 CRS (requires hospitalisation) and 0% a grade 4 CRS (requires ventilation). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142489 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142489 To me as a non impacted layman, the side effects of even one of the several chemotherapeutics one seems to get appear to be much more destructive, uncomfortable and scary than the well manageable CRS from blinatumomab that primarily appear in the first cycle. Also looks like after blinatumomab, there are now also "Anti-CD19 CAR T cells" available which are even more effective (but have stronger side effects). I hope I don't get cancer.
- dogman144 3y agoThat poison chemo was and is a vast improvement on puberty-killing radiation, for instance. It’s a spectrum