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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

#241

Post by refurb »

makomk wrote: post #131
twoodfin wrote: post #68

Earlier quoted context omitted.

That depends on the treatment and politicians’ willingness to pay for it. Take cystic fibrosis in England: Until this year, modern, highly effective (and, yes, expensive) treatments available for years in the US—covered at low out-of-pocket cost by insurers there—were unavailable through the NHS.

The same was true of hepatitis C in England - even though NICE, the body responsible for assessing what drugs should be available on the NHS, found that the new treatments were cost effective at the price they were being sold for, the NHS balked due to the total cost of curing everyone and refused to offer it to anyone except a handful of patients who already had severe liver damage.

This is true. The new HCV drugs, even at the outrage inducing price of $90k, easily met the NICE cost effectiveness threshold.

The issue was really volume. There wasn’t enough money to treat everyone.

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

#242

Post by refurb »

inasio wrote: post #161
idclip wrote: post #3

Earlier quoted context omitted.

Jesus how much did these drugs cost to develop? Are these numbers justified?

It cost exactly 11 billion for Gilead to "develop" Sofosbuvir (they bought Pharmasset who discovered the drug [1]) [1] https://en.wikipedia.org/wiki/Sofosbuvir#History

They didn’t buy an approved drug, they bought a clinical lead. They still spent a ton getting it approved.

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

#243

Post by gengchun88 »

inasio wrote: post #160
gengchun88 wrote: post #133

Earlier quoted context omitted.

If you are talking about a virus only affect small amount of population, I can understand this marketing strategy. But Hepatitis C. is a virus infects 143 million, which means it even with a $10k profit margin for one in ten here should be at least $1 Trillion profits. A company like BMS do expanding like $20 billion annually. For me all most like they could afford to operate like half of century for just one drug. N…

No, Gilead didn't develop Harvoni/Sovaldi/Sofosbuvir, it was originally discovered by Pharmasset, and then Gilead bought them for 11 billion [1] [1] https://en.wikipedia.org/wiki/Sofosbuvir#History

Oh, thanks.

That simplified R&D cost calculation. $11B for $3.5 m persons in U.S. and 90% successful rate means R&D cost(merge cost) definitely less than $4k per person.

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

#244

Post by [deleted] »

vilhelm_s wrote: post #147
ouid wrote: post #139

Earlier quoted context omitted.

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.

[deleted]

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

#245

Post by wtallis »

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…

> Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to.

The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.

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

#246

Post by Symmetry »

refurb wrote: post #231
heisenzombie wrote: post #211

Earlier quoted context omitted.

I’m not sure that assertion is borne out by the data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ I think two big missing factors in your analysis are (1) profit — US drug companies pocketed something around $30 billion dollars this year, and (2) inefficiency - something like $20 billion dollars went into deg marketing in the US for example, which seems to me like almost a complete waste.

Just measuring profit ignores all the companies who went under because their drug didn’t work. You’re just counting the winners. And marketing includes things like paying a sales rep to answer doctors questions. Are you saying they shouldn’t do that.

I was under the impression that the biggest driver of marketing costs for drugs was providing free samples of the drug to doctors, with training doctors coming second and advertisements a distant third.

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

#247

Post by tapland »

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…

And the moral one. You could have gotten any conceivable illness while having had optimal healthy habits forever.

The US pays around 2x the cost compared to any other country, and just as much as the others from taxes, presumably just to be able to say 'F YOU' to those who can't afford care.

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

#248

Post by heavyset_go »

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…

> 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.

Then you'll be happy to know the morbid truth: smokers and alcoholics have lower healthcare costs over their lifetimes because they tend to die earlier. If everyone smoke and drank to excess, your insurance costs would be lower.

However, this truth ignores another morbid truth: some people you love, maybe one of your kids, a relative or even perhaps even yourself, are statistically likely to smoke, drink or do drugs to excess.

> 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.

I mean, at least you recognize the irony. Empathy is learned, and perhaps you could learn to be empathetic towards others.

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

#249

Post by selimthegrim »

3fe9a03ccd14ca5 wrote: post #232
burfog wrote: post #226

Earlier quoted context omitted.

That is obviously not "full STD screening". Missing: human papilloma virus (HPV), mycoplasma genitalium, trichomoniasis, chancroid (haemophilus ducreyi), Lymphogranuloma venereum (LGV), Methicillin-resistant Staphylococcus aureus (MRSA), molluscum contagiosum, scabies, crabs

MRSA is an STD?

Skin to skin contact

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

#250

Post by lmm »

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?

Late-stage trials are enormously costly and negative results are common. To publicly fund them, we'd have to be ok with governments spending billions and getting nothing for it. And after the fact there'd be a long line of people saying how $treatment was obviously never going to work and only an idiot would ever have let it go forward for stage 3 trials.

I'm not opposed to the idea, but I think you'd struggle to make it politically achievable.

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