This, from Kaiser Health News via the Chicago Tribune:
A pair of potent new drugs can cure the vast majority of patients infected with hepatitis C . . . One of them, called Sovaldi, costs $1,000 a pill — $84,000 for a typical 12-week course. The other, Olysio, costs around $66,000.
The article profiles Walter Bianco, who succeeded in getting Medicare approval for this drug regimen, but it sounds as if this is the tip of the iceberg.
Researchers estimate that 3 million to 5 million Americans carry the hepatitis C virus. The biggest concentration of cases is among those born between 1945 and 1965.
Hepatitis C is a slow-acting virus, but a growing number of people who got infected in the 1960s through the 1990s have now “used up” the infection’s latency period, said Dr. Camilla Graham of Beth Israel Deaconess Medical Center in Boston, “which is why we’re now seeing this dramatic increase in the number of people developing complications and dying of hepatitis. And we expect this to continue to increase for the next 10 years.”
The problem for Medicare, as well as for private insurers, is the price of the newest medications. Others in the pipeline are also expected to be costly. “People were very shocked about the price because it hit a psychological barrier in terms of ‘This is too expensive,'” Graham said. Medicare officials are well-aware of the potential expense, which some say could run into the tens or hundreds of billions of dollars.
Sean Cavanaugh, a Medicare deputy director, told a U.S. Chamber of Commerce summit this month that the agency won’t know the likely cost impact until it receives bids from the private health plans that administer its Part D drug plan in coming weeks. Those bids will have to take the cost of the new drugs into account.
This is a stunner. $150,000 for a drug regimen that could potentially be used by 5 million people. Doing the math produces a pricetag of $750 billion.
The article continues:
Many hepatitis specialists and patient advocates are worried that the cost of the drugs will lead payers to limit access to patients who already have advanced liver disease, or even more narrowly, those who are on transplant waiting lists.
There are significant consequences if treatment is delayed too long. If a patient develops liver failure or cancer, treating those complications can cost an estimated $50,000 a year.
“Hepatitis C is a ticking time bomb,” said Graham. “We have a very limited amount of time to get in here and alter the course of the disease for a good number of people. And we either do that, and we do it well now, or we face a whole lot more people suffering severe complications of this disease.”
So then what? If Graham means to say that Medicare and/or private insurance should pay out $150,000 for everyone the minute they learn they’re infected, because otherwise complications will bring doctors’ bills well in excess of that over time, I would dispute this based on personal experience: that is, my grandfather died of cirrhosis (blamed on a Hepatitis C infection from 70 years prior, during his youth, not shooting up or drinking but in the various other ways that the virus was transmitted prior to modern sterilization and sanitation procedures) — at the age of 89. Well, OK, I’m no expert, but I’m guessing that for many, the latency period can be long indeed (either that, or there are deep family secrets that mean the latency period wasn’t nearly that long, but I find that unlikely), and that for a significant portion of those affected, as in the case of prostate cancer, something else can kill you first. I suppose, though, that, a generation later, there will be choices to be made: how much do you pay for the medical treatment for an 89-year-old, especially when it’s a pricetag laid out in black and white?
Of course, no mention is made of potential reductions in price. Does that mean that the cost does not bake in R&D; expenses, but that actual production of the drugs is simply very costly due to the nature of the drug? Or is this simply a matter of what the manufacturers think they can get away with, factoring in the question of which insurers will be obliged to cover the drug and under what circumstances?
(Yes, AIDS drugs are similarly expensive, but at least a much smaller portion of the population is infected. And even so, I find it appalling whenever I read reports of infections climbing due to men not curbing risky behavior because, in their minds, it’s a treatable disease and someone else’s money that’s paying for the jaw-droppingly expensive treatment.)
And still: $750 billion? $150,000? How do we bend the cost curve under such circumstances?
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