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Some context. One of the drugs in the combination Ipillimumab has been used for a while now, and seems to produce long term survival in about 10% of patients wi
by Gatsky 11y ago
Some context. One of the drugs in the combination Ipillimumab has been used for a while now, and seems to produce long term survival in about 10% of patients with incurable melanoma. Some of these patients seem effectively cured, having survived 7 years or more without any other treatment. It seems likely that combination therapy will produce a better rate of effective cure. This is a pretty big deal, because advanced melanoma is otherwise a disastrous cancer to have.
Cost effectiveness... well ipillimumab costs 100k a year for 4 doses, and nivolumab is probably going to cost another 100k at least on top of that, and is generally continued indefinitely, and the medication to turn off overly vigorous immune responses can also be expensive...
But this is modern medical science how it should be. These are incredible, life changing drugs. The hype is justified. They are already spreading through many different types of cancer: lung, renal cancer, liver cancer, some breast cancer, some colon cancers.
Toxicity is an issue, but this is generally temporary, and the quality of life tradeoff is different when there is the possibility of making the next 7 christmases. Furthermore, you have to balance the toxicity with the symptoms from progressive cancer or old style ineffective chemotherapy.
- coldtea 11y ago>Cost effectiveness... well ipillimumab costs 100k a year for 4 doses, and nivolumab is probably going to cost another 100k at least on top of that, and is generally continued indefinitely, and the medication to turn off overly vigorous immune responses can also be expensive... I cannot imagine a chemical process to create those drugs that justifies the prices mentioned. Is the price at least subsidising the costs of research, or is it an arbitrary price set by the drug company because "it can"?
- eropple 11y agoLittle of column A, little of column B. The research is expensive. But living is effectively priceless. There are solutions to this, and countries that are not mine will probably avail themselves of them sooner or later.
- onewaystreet 11y agoAren't the prices for these drugs so high because they basically have to be made by hand? Since these small drug companies don't have any real manufacturing capabilities.
- possibilistic 11y agoipilimumab, *-umab; hUman Monoclonal Ab (antibody) These aren't cheap to mass produce. Edit: Not the best source I could find, but this cites costs (not at scale) : http://www.immunochemistry.com/services/antibody-development http://www.immunochemistry.com/services/antibody-development
- MacsHeadroom 11y ago>These aren't cheap to mass produce. Even still, $25k/pill seems steep. That's roughly 10x the cost of pure plutonium.
- ccvannorman 11y agoThere's an "ounce of prevention, pound of cure" joke in here somewhere :P
- marincounty 11y agoLet's not forget some people look at curing people suffering form disease as just an Investment? These biomedical companies are in business to make shareholders rich--it's just about the money. Maybe medicine has always been just about the money? The prices most drug comapnies charge for their latest drug seem outrageous? Want a jaw dropper--look into Biomarin drug prices. Read their prospectus--it reads more like a hedge fund, rather than bio company. Oh, and one of their buildings is sitting on the San Andreas Fault. Found that last sentance interesting--I guess lawyers were being proactive? But then again, I'm for government funded research, I would like to outlaw forprofit Insurance, and I have become a huge skeptic of modern medicine. (As a side note; If you noticed your generic drug is not dropping in price like it did years past, you are not loosing your mind. Supposedly, large drug companies(companies whose drug patents are expiring, or expired) are buying smaller generic drug companies, and either shutting down the operation, or keeping the generic price, of the newly aqquireed company, artificially priced high. I believe congress, or the FDA is looking into this slick business tactic? It's completely legal now.)
- dnautics 11y agoActual c cost to produce is probably in the 50k range (still a huge markup). Its a biologic - There is lots of batch to batch variation and some batches have to be chucked if they don't meet QC.
- lianwing 11y agoWouldn't insulin be considered a biologic? Would we ever see these drug prices come down to the price of insulin?
- dnautics 11y agoYes it is, and insulin is hard, but antibodies are even harder, mostly to do with the manufacturing platform "CHO". Also insulin is still more expensive than it should be due to patent ever greening. We would see prices of antibodies go down if the manufacturing could be switched to something "not CHO" but the IP landscape is locked up by a company! They will expire in 10 years or so.
- fasteo 11y agoDrug R+D plus approval processes are very expensive both in time (>10 years) and money (>2 American billions) [1] [1] http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014...
- jvvlimme 11y agoDon't believe everything they say. Tufts is financed by the pharmaceutical industry AND is based on data provided by the industry.
- datashovel 11y agoIn today's world it's hard to believe there are approval processes built to take > 10 years and > $2 billion. I would bet if these processes were carried out "transparently" we would find alot of waste and inefficiencies. I get the feeling things will change once Silicon Valley finally decides to get more invested in the pharmaceutical industry.
- ars 11y ago> I cannot imagine a chemical process to create those drugs that justifies the prices mentioned. It's a Monoclonal antibody, they are currently by far the most expensive drugs ever made. They are very difficult to make, and almost impossible to make in bulk. It's not a chemical process, it's a biological one. Unfortunately monoclonal antibodies are also some of the most promising drugs currently available. They can do things no other drug can. It's really too bad they are so expensive to make.
- moe 11y agoCould you give a brief explanation (in layman's terms) of why they are so difficult/expensive to make? Wikipedia[1] is full of jargon, but one caption says "Monoclonal antibodies can be grown in unlimited quantities in the bottles shown in this picture". So the process at least looks scalable. What materials/constraints can possibly cost $25k per dose? [1] http://en.wikipedia.org/wiki/Monoclonal_antibody#Production http://en.wikipedia.org/wiki/Monoclonal_antibody#Production
- calinet6 11y agoThe images are full of fluff. The bottles are only one step in the process described in the section after that, which includes a dozen or so complex steps, each of which must be executed perfectly. Doesn't look simple.
- jacobwcarlson 11y ago> But this is modern medical science how it should be. These are incredible, life changing drugs. My mother, after an involved but seemingly victorious war with breast cancer, was then found to have stage-4 cancer on her spine. But as you said, modern medical science is pretty amazing. What might have been a death sentence 10 years ago is now just a chronic ailment kept in check by an expensive pill and occasional radiation therapy.
- bjterry 11y agoTreatment is continued indefinitely, but the patent isn't. It won't cost $100K * remainingLifespan.
- philjohn 11y agoA distant family friend has been on Ipillimumab for about 8 years, and is still going strong. Amazing stuff.