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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

#191

Post by dfsegoat »

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 think your points are fair. Sample size for their analysis was about 100 drugs. FDA approves about 25 per year.

My main point is that drug development is more expensive than most realize. Beyond R&D, a lot of that cost is in postmarketing (after approval) safety studies and surveillance- to catch side effects not observed in clinical trials. This process can be made somewhat more efficient as you suggested, but at the end of the day a human is reviewing every side effect report and reporting those back to regulatory agencies etc.

I am not qualified to discuss the economics re: your point on pharma r&d - drug discovery is it’s own thing aside from actual drug development.

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

#192

Post by DoofusOfDeath »

jxramos wrote: post #163

Here's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects. "With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or doe…

This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals.

As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems.

On the other hand, as someone with chronic mild obesity, I'm grateful for government-funded research for treatments of hypertension, stroke, idiopathic cancer, etc. And to some extent I could, if motivated enough, keep my bodyweight down.

I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.

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

#193

Post by chimeracoder »

oleg_k wrote: post #140

I’m working on direct-to-consumer STD testing in JasonHealth.com . Some thoughts on Hep C testing: Hep C Antibody is a very inexpensive test. We charge $25 for it. It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks ( https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-d... ). Testing shortly after possible infection with this test is not…

> It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks

That's not much of a problem except for people worried about infection after a single known exposure (e.g. needlestick in a medical setting).

About a third of patients spontaneously clear the acute infection within six months. On top of that, some countries (such as Germany) refuse to treat acute infections with antivirals - so patients have to wait 6 months for the infection to develop into a chronic infection before they can take the medicine which cures it.

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

#194

Post by sorokod »

DoofusOfDeath wrote: post #192
jxramos wrote: post #163

Here's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects. "With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or doe…

This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals. As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. On the other hand, as someone with chronic mild obesit…

"This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals"

It's a moral question, not a political one. Food for thought: "Rough sleeper gives birth to twins outside wealthiest Cambridge college" - https://www.theguardian.com/society/2019/dec/26/rough-sleepe...

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

#195

Post by chimeracoder »

trimbo wrote: post #15
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…

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…

That's not true. A third of infected people spontaneously clear the virus (no chronic infection develops), and before antivirals, interferon-based treatment could cure about 50% of patients. Interferon wasn't fun - it's literally cancer treatment and has similar side effects to chemotherapy, but it's not true that people would necessarily need a liver transplant eventually.

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

#196

Post by greenyoda »

tyingq wrote: post #42
latortuga wrote: post #22

Earlier quoted context omitted.

Also blood transfusions, which could be a wide variety of folks that have had routine surgeries, including, for example, c-sections.

I imagine a fair amount is also from unprotected sex with high risk partners.

"Sexual transmission of hepatitis C is uncommon."

https://en.wikipedia.org/wiki/Hepatitis_C#Sexual_intercourse

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

#197

Post by chimeracoder »

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…

> 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.

It's worth noting that, in the US, almost nobody is actually paying those prices. Most insurance plans these days cover HCV treatment, and even insurance companies aren't paying those sticker prices to the pharmaceutical companies when they cover these drugs.

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

#198

Post by chimeracoder »

3fe9a03ccd14ca5 wrote: post #91
coder1001 wrote: post #20

Earlier quoted context omitted.

or go to India now and be treated for $1k [1]? [1] https://www.medicaltourismmag.com/article/hepatitis-c-treatm...

It’s basically to the point where it’s: > Go to and be treated for

> It’s basically to the point where it’s:

> > Go to and be treated for

For Hepatitis C? Absolutely not. It's way easier for US citizens to access the drugs to cure HCV in the US than it is for, say, British citizens to access it in the UK.

If you want to talk about other conditions, fine, but for Hepatitis C, this statements is patently false.

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

#199

Post by inasio »

jp57 wrote: post #170

The article says nothing about the false positive and false negative rates of the test, and proceeds as if the screening is infallible. Even given what was said in the article, one has to assume that the incidence of the infection in the general population is quite low—probably measured in basis points—which means that the false positive rate of the test would have to be very low to get a high positive predictive val…

The two key groups in western countries are baby-boomers (likely acquired the infection from dentists/doctors reusing needles), and intravenous drug users. The best bang for your buck is in testing and treating this last population, but you have to be careful and try to do followups to prevent reinfection. It's worthwhile to test the baby boomer population as many of them could require liver transplants soon if not detected

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

#200

Post by chimeracoder »

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.

> Can’t imagine having to decide to risk my entire financial future to deal with Hep C.

You'll be glad then to hear that very few people actually are.

Those prices that are cited are meaningless - most insurance plans these days will cover the drugs, and even the insurance companies aren't paying those prices to the pharmaceutical companies, because there's such fierce competition among the companies producing HCV drugs that they'll cut deals with the insurer for a tiny fraction of those sticker prices.

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