Hepatitis C kills more Americans than all other infectious diseases combined • Hacker News Board

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

#141

Post by lol2143651 » Thu, Dec 26, 2019, 5:11 PM UTC

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.

The way it generally works for these drugs is the insured get it covered and the uninsured get it cheap or free.

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

#142

Post by chmod775 » Thu, Dec 26, 2019, 5:16 PM UTC

hep_c_throwaway wrote: post #92

LinuxBender wrote: post #80

This is likely going to be an unpopular question and maybe I m just really naive, but is the protein really so complex to synthesize that a kit could not be made to make a small batch at home? I ask this because I have recently been studying what is required to produce non naturally occurring amino acids and while not trivial, it can be done. Are there not biohackers that figure these things out as a hobby? I know, t…

I paid $1300 for a 12 weeks course of generic Harvoni from India. I paid using credit card and it arrived within a week. Normally I'm a law-abiding citizen, but as you said, if it comes down to choosing between violating intellectual property laws and death, it's an easy choice to make.

Considering even a 12 week vacation in India while you undergo treatment is cheaper than the alternative and also legal, the pricing of the US drugs is very... interesting.

There's probably plenty of other countries where you could get treatment for cheap too.

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

#143

Post by idclip » Thu, Dec 26, 2019, 5:17 PM UTC

yoloClin wrote: post #98

dfsegoat wrote: post #66

Earlier quoted context omitted.

The development costs per a Forbes analysis are as follows: > "The median per-drug R&D spending of companies that developed more than six drugs – that’s only 8 companies – was $5.8 billion." ...so that is $5-6B USD per drug DEVELOPED in large companies. Gilead - maker of Sovaldi/Harvoni for HepC treatment - has been on a development tear of late, and almost certainly falls into that range IMO [2]. For companies that…

I imagine those numbers wouldn't be all that reliable for a bunch of reasons - companies would have vested interests in over or under reporting costs for various reasons, technology progressions mean previously expensive to develop drugs may be cheaper if they were to be redeveloped now, and sample size probably wouldn't be large enough for the raw data to be used when bankrolling pharma research ventures. Edit: I sh…

I dont think you should be downvoted because thats valid, yet hard to use as an argument, paranoia.

The basic assummption in cryptography is “assume the target system is already compromised” so i would wager you are partially correct. Its just that its not the whole story, especially if u think that private persons get massssive discounts if they try to privately pay (from reading below comments about quotes to insurance companies vs private people).

Its a sad dynamic thats probably ruining more loves than it should.

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

#144

Post by vilhelm_s » Thu, Dec 26, 2019, 5:18 PM UTC

phkahler wrote: post #129

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…

>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already maki…

I think it's the "right" price, you want to incentivize companies to try to develop drugs that will do the maximal amount of good.

Like, you could imagine a system where you don't have a free market at all, the government would directly fund both medical treatment (like in Europe) and medical research (like nowhere right now, but you could imagine nationalizing the drug companies). So then, before the hepatitis-c drug exists, you are paying $500k for each liver transplant, and you try to figure out how much money should be allocated to that drug research program. You'd want to fund it at roughly the expected cost saving, multiplied by the probability that the drug development is successful.

In the actual system, if the drug companies try to develop the drugs, and then charge about the same price as the cost of the previous treatment during the time they hold the patent, then their expected payoff (so how much money they will put into research) is the cost of the previous treatment times the probability that they will be successful---so this high price is basically what we would want to allocate anyway. And if the drugs are paid for by the government, their expected spending over all the drugs is similar to optimal amount of direct research funding.

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

#145

Post by pgeorgi » Thu, Dec 26, 2019, 5:21 PM UTC

juskrey wrote: post #126

hep_c_throwaway wrote: post #122

Earlier quoted context omitted.

Yes, I got it from a blood transfusion when I was a child. The Hepatitis C virus wasn't identified until 1989, and blood bank wasn't wide spread until early 1990s, so anyone who received a blood transfusion before then is at risk.

So you WERE in the high risk group after all, you can't advice anyone out of the risk group to start using unnecessary medical procedures.

The original post was about covered preventative measures. They're not "unnecessary medical procedures", otherwise insurances would get rid of their obligation to pay for them. They don't advertise them a lot, which is the only thing OP did.

Therefore: Check what your insurance (and/or local governance) considers essential preventative care and discuss with a professional which of these make sense for you. Then go and do it: it's important enough that some bean counter wasn't able to remove it from your plan as unnecessary medical procedure and it's already budgeted.

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

#146

Post by HarryHirsch » Thu, Dec 26, 2019, 5:22 PM UTC

ouid wrote: post #139

HarryHirsch wrote: post #136

Earlier quoted context omitted.

With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capi…

Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.

The early research is done on federal grants. What costs real money is late-stage development and especially clinical research, startups and universities are not at all equipped for that.

The financing model is problematic. Return on investment is much higher and faster in IT, besides there is a mismatch between what the market favours and where future clinical needs are (the antibiotic crisis, neglected tropical diseases).

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

#147

Post by vilhelm_s » Thu, Dec 26, 2019, 5:24 PM UTC

ouid wrote: post #139

HarryHirsch wrote: post #136

Earlier quoted context omitted.

With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capi…

Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.

The government mostly funds basic research, but then there is a lot of work to turn promising leads into products. Googling a bit, in 2017 the pharma companies spent $70 billion on research while the NIH spent $38 billion.

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

#148

Post by dghughes » Thu, Dec 26, 2019, 5:25 PM UTC

tyingq wrote: post #71

georgeplusplus wrote: post #61

Earlier quoted context omitted.

Wrong. Gilead made Harvoni. Pharmasset made Sovaldi. Is there something that’s supposed to be inherently evil in acquiring a company anyway? Because pharmasset, the smaller company, had forecasted a price of 36000$ for Solvadi. With Gilead buying it out, it was able to reach a third of that price point and that’s a win to me.

Harvoni is a combination of Sofosbuvir (Sovaldi) and Ledipasvir. Pharmasset discovered Sofosbuvir (Sovaldi), Gilead acquired them in 2011. Gilead developed Ledipasvir some time after that. I was contesting the phrase "literally made a cure for a previously uncureable disease" . Which is why I called out the acquisition. They literally bought it, not made it.

Here in Canada there is some debate over sofosbuvir and velpatasvir their cost. A person may be cured of hepatitis C in just a few months. That would be fantastic for them since done soon enough may prevent liver fibrosis. And really for the tax payers here in socialized medical land it saves money by not treating infected people for decades.

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

#149

Post by pgeorgi » Thu, Dec 26, 2019, 5:26 PM UTC

ouid wrote: post #139

HarryHirsch wrote: post #136

Earlier quoted context omitted.

With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capi…

Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.

> I thought most of this research was done on federal grants

And if not, why not? There may be folks who think public research grants shouldn't exist, but since they do, what else would be worthy of such support if not public health research?

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

#150

Post by inasio » Thu, Dec 26, 2019, 5:26 PM UTC

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…

I used to do HCV research in British Columbia. Something that might be useful for you if you haven't yet started treatment is to see if you qualify for a settlement. In BC in particular there was a class action lawsuit the compensated people infected from blood products (between 1986 and 1990) [1]

[1] https://www.callkleinlawyers.com/class-actions/settled/hepat...