{"id":7669,"date":"2015-09-07T12:08:56","date_gmt":"2015-09-07T16:08:56","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7669"},"modified":"2015-09-07T16:21:11","modified_gmt":"2015-09-07T20:21:11","slug":"two-drugs-with-high-prices-one-is-surprise-good-value-the-other-is-truly-a-rip-off","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/two-drugs-with-high-prices-one-is-surprise-good-value-the-other-is-truly-a-rip-off\/2015\/09\/07\/","title":{"rendered":"Two Drugs with High Prices — One is (Surprise!) Good Value, The Other is Truly a Rip-off"},"content":{"rendered":"

\"cat\"<\/a>By now, the fact that HCV treatment carries a high price is a fact as well known to the medical and non-medical public as 1) a million dollars doesn’t get you much in Manhattan or Bay-area real estate; 2) a Rolex is an expensive way to know what time it is; and 3) even though a Tesla\u00a0doesn’t need gas, buying one\u00a0won’t save you money.<\/p>\n

But you know what? Something interesting has happened since the initial sticker-shock of the $1000\/day pill and the cries of injustice from patients, the medical community, and activists. First, the price has been aggressively negotiated, and now is substantially lower — various unofficial estimates suggest the actual cost\u00a0is around 50% of the wholesale acquisition cost.<\/a>\u00a0Still high, yes, but much<\/em> less than the dizzying cost of HCV treatment during the\u00a0“SIM-SOF” days in early 2014.<\/p>\n

Second, a careful analysis of this miraculous therapy shows it’s actually decent value. In other words, you pay a lot, but you get a lot too — this is what the cost-effectiveness literature shows (several citations in bullet number two at this link<\/a>), and the public is starting to take notice. An editorial last\u00a0week in the Times<\/em><\/a>\u00a0got it right (though it could have used a bit of quick medical editing, which I’ve provided):<\/p>\n

The benefits of these new drugs are undeniable. They can essentially cure [not essentially <\/em>cure\u00a0— they do<\/em> cure] the infection in eight to 24 weeks… Curing the patient decreases by more than 80 percent the risk of liver cancer, liver failure and the need for a liver transplant, thus saving money in the long run. Successful treatment can also greatly reduce the number of new cases of hepatitis C by preventing transmission of the virus through needle-sharing among drug addicts infected with HIV [HIV has nothing\u00a0to do with it]… the\u00a0Institute for Clinical and Economic Review, previously a skeptic, estimated that a likely course of treatment with Harvoni would make it a high value for individual patients and for most health care systems.<\/p><\/blockquote>\n

The editorial goes on to recommend lifting restrictions on treatment, in particular for those who don’t have advanced liver disease. This makes all kinds of medical sense, and will be great comfort to those of us battling with payors to get treatment to people before<\/em> they have irreversible liver damage from HCV.<\/p>\n

Meanwhile,\u00a0one of our relatively obscure antimicrobials — pyrimethamine — has suddenly become staggeringly expensive.<\/a>\u00a0Used as part of treatment of toxoplasmosis (in particular for patients with AIDS), and rarely for malaria, pyrimethamine has been around for decades. A single pyrimethamine tablet, previously $13.50, now costs $750 — that’s a more than 50-fold increase.<\/p>\n

It’s not as if new research funded by industry\u00a0has found some novel indication for a previously underused drug.\u00a0Nope,\u00a0this is pure monopolistic pricing — in mid-August, a company\u00a0purchased the rights to pyrimethamine<\/a>, becoming the exclusive US distributor. As with the colchicine saga<\/a>, this exclusivity allows them to dramatically drive up the price because, well, they can.<\/p>\n

In short, sometimes you get what you pay for — and, at least in the case of pyrimethamine, sometimes you don’t.<\/p>\n

Hey, this video doesn’t cover treatment, but it sure is funny!<\/p>\n

[youtube http:\/\/www.youtube.com\/watch?v=U9MU-FxsKRg?list=PLoeuxutUxJnkmhX6Rw9mBf_dDEkEy4-VH]<\/p>\n","protected":false},"excerpt":{"rendered":"

By now, the fact that HCV treatment carries a high price is a fact as well known to the medical and non-medical public as 1) a million dollars doesn’t get you much in Manhattan or Bay-area real estate; 2) a Rolex is an expensive way to know what time it is; and 3) even though […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[44,1072,408,936],"class_list":["post-7669","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-aids","tag-cost-effectiveness","tag-hcv","tag-toxoplasmosis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7669","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=7669"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7669\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=7669"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=7669"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=7669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}