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Hepatitis C kills more Americans than all other infectious diseases combined

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Re: Hepatitis C kills more Americans than all other infectious diseases combined

#101

Post by 0xB31B1B »

deith wrote: post #89
trimbo wrote: post #15

Earlier quoted context omitted.

They're priced this way because they're 80-90% cheaper than the previous treatment. Previously, with no cure, HepC patients would have eventually had a liver transplant. Liver transplants cost between $500K-$1M. Of course, it also requires a liver, so many would die waiting for a liver. As you noted, the drugs have become much cheaper. Mavyret is ~1/2 the cost of Sovaldi, the first drug on the market (replaced by Har…

Pro-tip: it doesn't actually cost $500K-1M to transplant a liver (which you get for free).

It costs an insane amount of money.

1) there is a large infrastructure around organ donations that needs to be maintained

2) it generally requires the organ (and some times doctor) to be flown on a private jet from where the organ comes from to the person receiving the transplant

3) transplant surgery is a very long procedure requiring multiple specialists

4) recipient is on a lifelong course of drugs (literally like a handful of expensive drugs every day) that suppresses their immune system so the body doesn’t reject the organ

Source: wife is a doctor at research hospital

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#102

Post by sp332 »

save_ferris wrote: post #5
yakz wrote: post #2

Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. The price of other hepatitis C drugs is also high: Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatmen…

That is so depressing to read. US pharma companies are completely out of control, there’s absolutely no reason a 12 week treatment should cost around the mean annual US income. Can’t imagine having to decide to risk my entire financial future to deal with Hep C.

Have you wondered why, with so many potential customers, no one developed such a drug before if it were cheap and easy?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#103

Post by claudeganon »

jacquesm wrote: post #18
lawn wrote: post #14

Earlier quoted context omitted.

Ability to pay? Is that a joke? Considering that 40% of Americans can't cover a $400 emergency expense[0], what makes you think they can pay $84,000 for a 12-week treatment? [0]: https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...

Maximized for the total bottom line it isn't a joke. That some people die is not a consideration for those that control access to these drugs, the question is how many people should die in order for them to make the most money of the ones that stay alive. Think of the ones that die as marketing.

This is the only sincere appraisal of the healthcare industry in the US I’ve seen on HN in months. Thank you for your clarity.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#104

Post by crobertsbmw »

hep_c_throwaway wrote: post #62

Using a throwaway for obvious reasons. Like many of you, I'm a young and healthy guy. I haven't taken a sick day in years. Since I'm young and healthy, I didn't see the need to take an annual physical exam. Scheduling doctor's appointments is such a hassle. I'm sure many of you feel the same. So when I was diagnosed with Hepatitis C, it came as a complete shock to me. The shock was due to two reasons: 1. I wasn't inv…

Did you ever figure out why you got HepC? Did you conclude that you had it from birth, or did you remember that you stepped on a nail while traveling in Vietnam?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#105

Post by lotsofpulp »

phonon wrote: post #90
lotsofpulp wrote: post #47

Earlier quoted context omitted.

Health insurance in the US has overhead capped at a maximum of 20%, or 15% in large employer groups. https://www.healthcare.gov/health-care-law-protections/rate-...

What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).

Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#106

Post by [deleted] »

bra4you wrote: post #99
yakz wrote: post #2

Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. The price of other hepatitis C drugs is also high: Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatmen…

"Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatment" I assume that your healthcare covers this. Otherwise cheap imports are available from India, e.g. https://roidgear.net/hepatitis-c

[deleted]

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#107

Post by Sacho »

chmod775 wrote: post #34
nkozyra wrote: post #21

Earlier quoted context omitted.

As with most commercial goods there's a market identified and the goods priced accordingly to maximize profit. This means that somebody is priced out no matter what. Given the state of American healthcare it's easier to reconcile if you remove the emotional part and view a drug treatment as, say, a television. If I make a 50" television and price it at $500, I accept that some people will not buy it and target my tel…

> All that said, if it's life saving you might be surprised what people can and will do, savings notwithstanding. Withholding a life-saving treatment has to be criminal in some way. I just can't imagine a hospital sending people home to die because they can't pay.

You'd be looking to criminalize rational behavior - a difficult and quite often counter-productive endeavour.

First, there's survivorship bias. The hospitals that eat the costs of saving lives eventually go under or can't compete with the ones that invest in better doctors, equipment and so on. What you see in the end is lots more hospitals who are willing to withhold life-saving treatments than ones that will treat anyone no matter what. We may in theory want everyone to be treated, but in practice, our market behavior of seeking cheaper treatments and better doctors sways hospital behavior as well.

Second, there's unintended consequences. A hospital going under to save some lives can have disastrous consequences on the rest of the community - non-life-threatening issues turn into fatalities with the hospital gone, leading to more lives lost than if the hospital was "cold-hearted" and "calculating". Hospitals are faced with this moral dilemma every time they do their budgeting.

Third, there's utilitarianism. Is saving one life no matter how costly the way to go? What if you can save two lives for the same price? Is saving an old person's life the same worth as saving a young one's? What about "saving" someone's life but leaving them functionally crippled, vs dealing with non-fatal conditions in people which might bring them back to full function? How should a hospital spend its finite resources?

When you mix in all these concerns with the practicalities of the situation(noone is working with perfect information, and hospital staff often has to make snap judgements), you're bound to get different outcomes, including sending people home to die, depending on how the hospital lands on this balancing act.

It's difficult enough to craft a law to deal with the moral issues, but then you also need to think of the legal issues in enforcing it, and how the enforcement could lead to further unwanted consequences. Then, purely from a utilitarian POV, think about funnelling all the costs of enforcement into a charity - which one is more effective?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#108

Post by anonuser123456 »

nkozyra wrote: post #58
wadkar wrote: post #37

Earlier quoted context omitted.

Taking the television example a bit far - one can imagine that one company makes radio, other makes ~telephones~ cellphones, oven, etc. These are all electronic gadgets that are used for different purposes. However, most if not the entirety of drugs is to cure disease and save lives (or significantly improve the quality of live). There is one market as opposed to a market each for the types of gadgets. Which is why s…

> The free market economy doesn’t work in this case. While I think this is self evident, it depends on your definition of "working." If we - a I personally think we should - attach a social caveat to capitalism that requires we do what we can for people less fortunate, it fails miserably because we lack a mechanism for fostering unfettered profit while ensuring healthcare is available to all in a reasonable form. No…

>If we - a I personally think we should - attach a social caveat to capitalism that requires we do what we can for people less fortunate, it fails miserably because we lack a mechanism for fostering unfettered profit

In the case of intellectual property/technology you are mistaken. Patents have an expiration. Capitalists are provided a time limited monopoly for the sake of extracting rent in exchange for development of that technology. But after the expiration, it becomes public domain.

In this case, all of the drugs mentioned will eventually run off patent and be available in generic form for very little cost. Future generations will benefit considerably. This is where the moral argument becomes most powerful. Think of the potentially tens to hundreds of billions of people that will benefit from this in the future. Should we stop the pipeline of drug development because some people can't afford it today?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#109

Post by claudeganon »

zwily wrote: post #57
baq wrote: post #41

Earlier quoted context omitted.

Basically any other country than US is a better alternative for the patient financially.

How many of these “miracle cures” are developed in the US?

And how much of that miracle cure development is on the backs of tax-payer funded research? The US would be better off having a fully nationalized and internationally collaborative drug research system.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#110

Post by sp332 »

dpark wrote: post #44
ameister14 wrote: post #32

Earlier quoted context omitted.

Most Americans wouldn't end up paying the 84k. Their insurance would pay for most of that, and negotiate it down further - the other day I was picking up a drug that without insurance would cost over $1,000. I paid $34.

That’s garbage. People without insurance are utterly fucked. The uninsured are sacrificed as a negotiating point against insurers. “List price is $5000. We’ll cut you a deal at only $2000!”

This is a valid thing to be concerned about, but it appears to be false. Gilead has programs that help uninsured people get their drugs, including Harvoni. https://www.gilead.com/purpose/medication-access/us-patient-...
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