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FDA approves first monthly injectable to treat HIV infection

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Re: FDA approves first monthly injectable to treat HIV infection

#201

Post by Animats »

abeppu wrote: post #73

> The cost, however, is steep — the list, or wholesale, price is $3,960 a month, or more than $47,500 a year. The list price for the one-time initiation dose is $5,490. Median income in the US is ~$31K apparently. So even in a rich country, this is like 50% more than the income of a typical person. My understanding is the funding for the trials was partly from NIAID. This seems like yet another case where public fund…

The cost, however, is steep — the list, or wholesale, price is $3,960 a month, or more than $47,500 a year. The list price for the one-time initiation dose is $5,490.

Supporting a subculture that's heavily into anal sex is extremely expensive.

Re: FDA approves first monthly injectable to treat HIV infection

#202

Post by simonklitj »

chrisfinazzo wrote: post #114
jennyyang wrote: post #77

As someone who grew up in the 80s with the fullblown AIDS crisis, this really is a testament to human ingenuity. When we were kids, this sounded like the end of the world: a virus that attacks the immune system itself. It was so terrifying to hear about such a horrible disease that had no cure, and was so insidious that we couldn't even create a vaccine to stop it. In a few decades we as a species have found a way no…

> When we were kids, this sounded like the end of the world: a virus that attacks the immune system itself. It was so terrifying to hear about such a horrible disease that had no cure, and was so insidious that we couldn't even create a vaccine to stop it. I was born in '86. Even into the 90's this line of thinking hadn't changed all that much. The attitude around most diseases and the like that had a 'social' compon…

I think the reason it's not considered cured is because if you go off of your meds it'll (might?) return and potentially gain resistance to the medication. So it's more like keeping it in check through active medication, not curing it away: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treat....

Re: FDA approves first monthly injectable to treat HIV infection

#203

Post by lwhi »

jklein11 wrote: post #189
lwhi wrote: post #150

Earlier quoted context omitted.

I'd imagine this cost would generally be borne by insurers or a government health care body.

I don't think either insurers or government health care bodies end up paying the sticker price. They usually have a contracted rate with the pharma companies that is less. Also, pharma companies have patient assistance programs which usually offer major discounts. I really don't know how effective this is and hhow many individuals get stuck with the full bill.

So is the sticker price rarely paid?

Re: FDA approves first monthly injectable to treat HIV infection

#204

Post by dang »

grawprog wrote: post #172
dang wrote: post #63

Earlier quoted context omitted.

It was a generic ideological flamewar tangent. That includes several good reasons for downvoting. https://news.ycombinator.com/newsguidelines.html

Thanks for pointing that out. Sorry for adding to an offtopic, flamewar inspiring subthread. I hoped providing some sources for the GP's comment might spur on some more productive discussion and i genuinely thought the other commenter was asking in good faith about sources for discussion. I was also genuinely curious as to the harsh reaction I do see now the flamewar aspect to it and didn't really stop to consider th…

Thanks—I appreciate that! We all underestimate how provocative our posts will end up being, usually by a good 10x. I struggle with this daily.

I think it's because in our mind, the comment is blended together with the intention behind the comment, which is usually benign. We take our intent for granted and assume it will come across, but of course the people who read it have no direct access to that intent, and often it doesn't come across.

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...

https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so...

Re: FDA approves first monthly injectable to treat HIV infection

#205

Post by dang »

lwhi wrote: post #155
dang wrote: post #87

Earlier quoted context omitted.

> Is the flamewar tangent part of this the comment on capitalism or "Capitalized medicine"? Doesn't really seem flamie to me but obviously others disagree. The problem is the generic ideological tangent. You can perhaps (maybe!) imagine a substantive article and thread on the economics of cures vs. treatments. But that would require different initial conditions—primarily an interesting, informative article that broug…

More time has been spent discussing the nature of flamewars. A little ironic perhaps ..

If you mean in this case, that may be, but it's certainly not true in the general case.

Moderation comments have multiple functions. If it were just about this specific case it wouldn't be worth spending so much time on it, but they're also opportunities to explain the principles of this site to readers who might not have encountered those principles yet.

For those who do already know this stuff, it's true that such comments are tedious. I'm sorry about that. If it helps at all, they're even more tedious to write than they are to read.

https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so...

Re: FDA approves first monthly injectable to treat HIV infection

#206

Post by jacquesm »

malandrew wrote: post #182
jacquesm wrote: post #129

Earlier quoted context omitted.

That doesn't scale. If you push the cost of healthcare to other countries when it becomes too expensive instead of fixing the system in the country where you live then every other country with a better system's healthcare will collapse as well. Vote to improve the system where you live and make sure that your representatives realize that it could be them or their relatives in your situation. Quite a few countries hav…

From all my research, I've come to the conclusion that while there are things that are broken about the US system, it's not as fundamentally broken as people make it out to be. Let's say there are two variables you can optimize for, X and Y, and that there are tradeoffs between optimizations such as optimizing for X often reduces Y and optimizing for Y often reduces X. The problem with the popular discussion today is…

This comment is in very start contrast with the sibling thread regarding insulin. If a common drug like that is price gouged to the point that people will do street deals on unverified product then things are about as fundamentally broken as they are going to get, fancy discussions about optimizations and trade-offs can be discarded by simply looking at the available evidence.

Re: FDA approves first monthly injectable to treat HIV infection

#207

Post by m12k »

peytn wrote: post #153
reimertz wrote: post #141

Earlier quoted context omitted.

You are definitely correct and thanks for pointing it out. Generalizations and miss-information doesn't help at all. I obviously need to go out for a walk before I comment on these type of news. It's super exciting but also extremely depressing since the ones who'd need this the most likely wont afford it.

The FDA approves ~40 drugs a year. If you want 40 new drugs a year, it unfortunately will cost somebody something to coordinate the large number of professionals over many years required by a modern development effort. Few drugs have been developed successfully on good intentions. I find excitement in the fact that we have found a way to get new treatments and cures. Other systems have been tried that weren’t so succ…

Could you elaborate a bit about which other systems have been tried, that weren't as successful?

Re: FDA approves first monthly injectable to treat HIV infection

#208

Post by jacquesm »

disabled wrote: post #193
jacquesm wrote: post #157

Earlier quoted context omitted.

Before long they'll be smuggling insulin rather than cocaine if it isn't already happening.

They already do. People buy insulin off Craigslist, in a way that is similar to a drug deal, because they cannot get it elsewhere. They sit in the car while their “insulin dealer” brings them the insulin from Mexico/Canada and they pay them in cash. See: https://youtu.be/VLwDvK0j4DQ

Words fail.

Re: FDA approves first monthly injectable to treat HIV infection

#209

Post by lwhi »

dang wrote: post #205
lwhi wrote: post #155

Earlier quoted context omitted.

More time has been spent discussing the nature of flamewars. A little ironic perhaps ..

If you mean in this case, that may be, but it's certainly not true in the general case. Moderation comments have multiple functions. If it were just about this specific case it wouldn't be worth spending so much time on it, but they're also opportunities to explain the principles of this site to readers who might not have encountered those principles yet. For those who do already know this stuff, it's true that such…

I know I've been more snarky recently than I'd like have been.

Lockdown in various countries is definitely bringing out the worst in people, some of the time; I obviously include myself this in this.

Can't be easy moderating during a pandemic. Thanks for doing a good job.

Re: FDA approves first monthly injectable to treat HIV infection

#210

Post by refurb »

gibybo wrote: post #198
refurb wrote: post #135

Earlier quoted context omitted.

Pharmacy is about 10% of total healthcare costs so not a major driver of rising healthcare costs, but it gets a lot of media attention. And no, they didn’t create an injectable drug because it’s “popular”. They did it because it address compliance of oral therapies.

>Pharmacy is about 10% of total healthcare costs That's good to know and something I've been curious about. Do you have a source that breaks down the other 90%?

Ok, so I work in healthcare in the US and I read a lot of papers and think "well yeah, but that's not very actionable information".

The best analysis I've found so far is from McKinsey.[1] They took a very clever approach to benchmark US healthcare spending to other OECD countries. They adjusted for US GDP (richer countries spend more on healthcare), then broke down costs by category and figured out how much more/less the US spent compared to OECD countries. Very eye opening if you check out the graph at the bottom of page 4.

Findings: 1) out-patient care is driving ~70% of the extra cost, 2) in-patient costs are ~10% higher than OECD, 3) the US spend 50% more on drugs, but it's a small part of overall spending, 4) administration is 200% higher, but again, it doesn't add up to that much, 5) the US spends less on long-term and home care and 6) the US invests 50% more in healthcare, but it's not a large absolute amount.

[1]https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...

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