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Comment by stochastic_monk | Hacker News Reader

The prohibitively expensive nature of any immunotherapy leaves me profoundly skeptical of its practical usefulness. $100,000/year? That's more than twice the median income in this country.

Is it simply that expensive to get mabs from animals, is drug development disgustingly expensive, or is there unbounded greed in pharmaceutical companies?

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It's way more than $100,000 a year too. My treatment alone (Keytruda, every 3 weeks) is around $300,000 a year; about double the price the company will quote you if you ask, because they don't estimate the cost it takes to get blood work, get seen by an oncologist, and then get the treatment administrated to you safely by a trained nurse ready to respond to any adverse events that may spontaneously occur during infusion. However, thanks to current health care law in the US there are caps on the amount of out-of-pocket expenses your insurance can charge you. I have run of the mill bigco health insurance and my personal max out-of-pocket cost (after premiums, deductibles, etc.) is at least two orders of magnitude less than the cost to insurance.

More then last 2 than the first one. Getting money from investors is much harder than getting MAbs from animals. Probably more gruesome, too. Also greed is not just the Pharma. Some Hospitals/physicians use Clinical Trials as a profit center, and see Pharma as a bottomless pit of cash-- its a bit of a vicious circle.

I've been in and out of the hospital a bit lately (broken back). That seems downright cheap. I average about $4,000 an hour when I'm in. The most recent "study" took an hour with one low paid tech using one ultrasound machine and it cost over $2,000. CT Scan? 15 minutes $7K. Heck, they charged nearly $800 to "start an IV" when they didn't even start it, it was the ambulance EMT that put it in (billed separately) they just injected morphine into it. If you don't have good insurance you are one small slip away from bankruptcy.

Have you tried shopping around?

https://www.healthcarebluebook.com and a bunch of others are trying to provide price transparency. Sometimes 30 min drive means thousands in savings.

CT scan is less than 100$ in most places in India. It could go up to 200$ in some hospitals and is considered expensive by the patients.

And ultrasound is 10-20$. I find it seriously expensive in US. One thing is the health insurance or public backed healthcare is not widely adopted and patients still pay from their own pockets in India so charging exorbitant amounts is a big no-no.

nothing is “prohibitively expensive” in healthcare unless you can’t afford your out of pocket costs, which is perhaps increasingly the case for a lot of people, but even conventional cancer treatment is still way over out of pocket costs, so I don’t see how the cost of this treatment really makes much of a difference.

if you don’t have health insurance, your floor for “prohibitively expensive” is probably way lower than this already.

It's all 3.

PhDs that have dedicated their lives to specializing in specific cancers, failed drugs, research that leads nowhere, failed clinical trials because of XYZ. It's all highly specialized. And if done with a rigorous protocol, it's all expensive.

You're not doing a lifetime of cancer research in hopes that you earn an average salary.

For the company, if you finally get somewhere with a drug that is affective, you have to try and recoup your investment. How else do you fund future research?

Most US medical research is highly dependent of public funding. Company's are only interested once the risks drop enough and the rewards are very near.

Looking at just research and eliminating patent dogging efforts, Drug companies don't pay for nearly as much research as you might think.

>One study assessed both capitalized and out-of-pocket costs as about US$1.8 billion and $870 million, respectively.

https://en.wikipedia.org/wiki/Cost_of_drug_development

These numbers certainly aren't risk-free. Even if the company has 10 billion in cash, how many potential research leads can they bring to market? Not many.

I agree that pubic funding is an essential foundation for this industry, but disagree that the risk drops before industry gets a hold of technology. Large clinical studies are crazy expensive for many good and many bad reasons, and many of them will fail giving zero ROI. I agree that much of Pharma, (especially, but not only, some very bad actors) spend more on IP Attys and Commercial efforts than R&D, and that hurts me to watch. Academia doesn't do the research that is required to get drugs to people--who does PK and ADME studies on hundreds of animals? No one excpet industry does the detailed manufacturing process development and critical parameter work required to support approvals, especially in biologics. Yes, many drug companies need to be fixed (and some outright eliminated), but the industry does serve a purpose.

Company's are only interested once the risks drop enough and the rewards are very near.

Clearly not true. Less than 5% of molecules that drug companies pick up make it to market. Huge failure rate.

1:20 is relatively good odds. A random molecule is something like 0.000000001%.

> How else do you fund future research?

Taxes?

That's kind-of what happens... only in the US, it's a huge tax on ill people, rather than a smaller tax on healthy people.

You have it exactly backwards. The healthy people are in fact paying for the ill people (who typically don't come even remotely close to ever paying for the cost of their treatment/care). The real cost to cover healthy people is extremely low, they pay artificially inflated prices for their insurance that subsidizes care & coverage for other sick people.

In the US, 5% of patients represent over 50% of the cost of healthcare. 1% of patients are 20% of all expenses. The healthiest 50% represent just 3% of the healthcare system's costs - they're the financial offset group.

For downvoters that find facts uncomfortable: that's why the ACA needed to force all people to have insurance, it's a financial necessity to get as many paying healthy people in the system as possible to financially offset the cost of sick people if you want to try to make it work. This is healthcare system 101.

> You have it exactly backwards. The healthy people are in fact paying for the ill people (who typically don't come even remotely close to ever paying for the cost of their treatment/care). The real cost to cover healthy people is extremely low, they pay artificially inflated prices for their insurance that subsidizes care & coverage for other sick people.

Agree - that's indeed how insurance works. :)

I was referring to high co-pays on vastly expensive new drugs, and was also being slightly facetious.

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