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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

#201

Post by chimeracoder »

blacksmith_tb wrote: post #185
samstave wrote: post #179

Earlier quoted context omitted.

Nice. It would be really great if you guys were to partner with other helping infrastructure, such as recovery centers, salvation army, homeless shelters etc... Getting more people tested for treatments on all levels is a good thing, IMO

Absolutely - but inexpensive testing may not help much when the cost of treatment is in the tens of thousands of dollars[1]. 1: https://www.medicalnewstoday.com/articles/323767.php#drug-ty...

> the cost of treatment is in the tens of thousands of dollars[1].

It really isn't. That's like walking in to a car dealership, asking how much the car is, and then accepting the salesman's first offer at face value.

In reality, insurance will typically cover HCV treatment in the US. Because there's so much competition between HCV drugs, the insurers are able to negotiate deals that are less than a tenth of what the sticker price is.

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

#202

Post by inasio »

hypewatch wrote: post #154

Hep C is a curable disease that doesn’t have any symptoms. It also tends to infect the most vulnerable among us - heroin addicts. So the root cause of this issue is not the disease itself but our society and health system. These victims are not receiving the testing and treatment they need because they choose not to or (more likely) can’t afford to go to the doctor.

From a purely epidemic control point of view the most rational path is to test this population as often as possible (every 6 months or less) and treat them immediately if testing positive. If you find people that reinfect rather than a bad thing this means you are being able to reach a core at-risk group.

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

#203

Post by greenyoda »

chmod775 wrote: post #142
hep_c_throwaway wrote: post #92

Earlier quoted context omitted.

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.

Hardly anyone with a regular job can just decide to take a 12 week vacation. You'd either have to convince your employer to let you take an unpaid medical leave (and you'd need to have enough savings to survive for 3 months), or you'd need to quit your job and hope to find another when you get back (not that easy for those outside the tech industry).

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

#204

Post by Waterluvian »

hep_c_throwaway wrote: post #184
Waterluvian wrote: post #174

Earlier quoted context omitted.

Completely out of curiosity: why did you need a blood transfusion as a child?

I have this genetic disorder called G6PD [0]. It's pretty common, with about 5% of human beings having it. Most people who have it go through life without ever finding out they have it, because it has almost no symptoms. One of the symptoms though is that eating fava beans can kill you. I basically ate a bunch of these beans and soon went into shock. I was rushed to the hospital but the doctors couldn't make an accur…

I'm so glad I asked. That was fascinating to read and further research. Thanks for sharing.

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

#205

Post by vsef »

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…

High prevalence of hcv isn't just due to lifestyle factors. Baby boomer age group for example have a very high prevalence primarily due to spread by unsafe medical practices before the medical community knew about hcv:

https://www.healthline.com/health/hepatitis-c/why-do-baby-bo...

Detection/treatment/control of infectious diseases has an additional intrinsically social dimension beyond the individual.

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

#206

Post by Retric »

lotsofpulp wrote: post #135
Retric wrote: post #124

Earlier quoted context omitted.

Governments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.

The government hires health insurance companies to do the inspections. I don't know of any US government that doesn't contract implementation of Medicaid/Medicare to UHG/Anthem/Humana/etc. So all the insurers have all the data anyway, and they are not inspecting each and every bill, they are also using heuristics.

Using heuristics on smaller sample sizes is inherently less efficient. You can get reasonable polling data on 50 million voters using 10,000 samples. That’s 1 sample per 5,000 voters. Drop the election down to a local election with 10,000 voters and the same ratio provides 2 samples telling you almost nothing.

Thus, if 5 insurance companies send patients to the same doctor you simply have more overhead.

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

#207

Post by [deleted] »

claudeganon wrote: post #180
HarryHirsch wrote: post #146

Earlier quoted context omitted.

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 dis…

Isn’t the solution then to build a national infrastructure for late stage trials as opposed to putting life-saving drugs behind a ludicrous paywall, whose price is determined by the opaque malfeasance of the healthcare system in the US?

[deleted]

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

#208

Post by masonic »

chimeracoder wrote: post #193
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 ac…

  That's not much of a problem
It certainly is a problem if they can infect others during that interval.

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

#209

Post by ohyes »

Cougher wrote: post #7
ohyes wrote: post #4

Earlier quoted context omitted.

It’s priced based on ability to pay. US it will be 100,000 other countries it will be less.

It isn't priced on the customer's ability to pay: it's priced on the companies' ability to gouge.

Well, it is discriminatory pricing. If someone isn’t saying it is too expensive you haven’t priced the product aggressively enough. In the US market the profit was maximized at 100k, in other markets the profit is maximized at a lower price level because almost no one can afford 100k.

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

#210

Post by masonic »

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…

  It's a pricing model in line with extortion
This common attitude is why I fear that we won't see true cures for anything, except perhaps from government labs.

This class of HepC drugs (Solvaldi et al) are cures. Not chronic treatments, but cures. The developer only has that one course of treatment to make all the revenue they ever will on that patient.

So what happens when they are told that they can't charge prices commensurate with the result? They'll abandon a cure model for treatments that have ongoing chronic purchases to provide revenue streams over time.

Imagine this category of HepC drugs being marketed as a $999/month regimen for life rather than $50K for a one time cure. They would face far less friction. Happy now, consumers?

This is why new antibiotic research was abandoned, by and large.

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