The price of improving lives through chemistry is puzzling

We live in extraordinary times of advancement in medical treatments.

Immunotherapy is revolutionizing cancer treatment, controlling and even curing tumors that would have been rapidly fatal just a few years ago. We can now cure more than 98% of chronic hepatitis C (one of the leading causes of liver failure).

Recently, two new drugs were approved by the FDA for the early treatment of Alzheimer’s disease.

Unfortunately, the benefits of this drug were only so-so, as the drug only slowed the relentless progression of the disease, and the price—$78,800 per patient—was eye-popping. Still, it represents the best progress we have made in treating this common and devastating disease.

Perhaps most newsworthy, however, are two drugs on the market – with more on the way – that promote significant weight loss. This is the holy grail of the pharmaceutical industry.

In addition, these drugs can control or help prevent diabetes and reduce the risk of heart disease and stroke.

Well, we are fortunate to have made significant progress against some of the most common medical diseases – cancer, dementia, hepatitis C, diabetes and obesity. That’s obviously cause for celebration, except for one thing: the cost.

I’ve noticed the cost of Alzheimer’s medications.

The drug is only available to people with early-stage dementia, so most Alzheimer’s patients won’t qualify. Still, at current treatment costs, the bill would provide roughly $160 billion for more than 2 million eligible Americans.

This means that the entire Medicare budget will increase by 21%.

One advantage is that, at least according to current research, this treatment only needs to be done once. However, this may change if future studies show that repeated treatment is beneficial.

The cost of cancer treatment has also risen significantly.

In 2000, the cost of new cancer drugs was approximately $2,000 per month. By 2014, it had risen to $10,000 per month and has continued to rise ever since.

New immunotherapy drugs sometimes show surprising efficacy, but come with eye-catching price tags.

For example, the drug Imfinzi, used to treat certain types of lung cancer, has an average lifespan of 2.4 years. But it also adds more than $100,000 to the average cost of treatment, bringing it to a whopping $245,000.

Treatments for chronic hepatitis C are so good that if we treated all 2.4 million Americans with the disease, we could almost eradicate it. The cost of treatment per patient has dropped to $24,000, a quarter of what it was a few years ago.

Still, that’s $58 billion for a disease that can cause cirrhosis and death, even though it occurs in only a small number of patients.While not cheap, in the long run the treatment could prevent cirrhosis and liver cancer in hundreds of thousands of patients and make the disease rare in the United States

The truly huge potential cost, however, comes from treating obesity, which affects 42 percent of Americans.

The new drug, called a GLP-1 agonist, can lead to weight loss of up to 24% within a year, similar to the effects of bariatric surgery. They may also treat diabetes, prevent heart disease and stroke, reduce kidney failure, and improve symptoms of certain types of heart failure.

Recent reports suggest they may even blunt addicts’ cravings for alcohol and tobacco. The list of benefits is so long, I wouldn’t be surprised if they could cure bad breath and baldness.

Medications in this category include Ozempic and Mounjaro, which reduce appetite. But remarkably, we don’t know why or how.

After years of unsuccessful attempts to achieve weight loss by targeting appetite hormones, drugmakers have unexpectedly succeeded in launching a drug aimed at treating diabetes.

Of course, the issue again is cost.

The weight loss effects of this class of drugs (the main current examples being Ozempic and Mounjaro) only last as long as they are used. Stop them and the weight will come back.

But both drugs cost about $14,000 a year. Competing drugs that are about to hit the market are likely to cost about the same.

Americans currently spend approximately $60 billion each year on weight loss. If we treated all obese people in the United States with these new drugs, the cost would be more than $2 trillion per year.

That’s half of all health care spending in the United States. That’s more than the Department of Defense and Medicare budgets combined.

Obviously, we would not be willing to increase health care spending by 50%, or $65,000 per person per year. At this price point, bariatric surgery is more cost-effective, costing as much as a year of Ozempic and providing long-lasting results.

These drugs have sparked a battle. The money to be made from them is staggering, and pharmaceutical companies will fight tooth and nail.

Insurance companies will try to limit the number of patients who receive coverage. But given its broad benefits, narrowing the number of people eligible will be a challenge.

I suspect demand for these drugs will cause prices to come down, although it’s difficult to say how soon that will happen. There is no doubt that people will go abroad to obtain supplies from countries with price controls.

The government now has the power to bargain with companies over the cost of drugs covered by Medicare, potentially lowering prices eventually. Generic drugs will continue to be available, which may drive down prices even in a highly competitive pharmaceutical industry.

New drugs will bring widespread benefits, sooner than we think. The battle between pharmaceutical companies and payers (insurers and consumers) will never end.

Rising medical costs seem almost inevitable. But if we became thinner, had fewer cancers, said goodbye to hepatitis C and reduced the burden of dementia, we would probably be willing to spend more to live better, longer lives.

Guest writer Scott Gibson returned to his childhood home 30 years ago to practice medicine. A board-certified intern, he served on the McMinnville School Board from 2011 to 2017, when he and his wife, Melody, moved to suburban Amity to open Bella Collina B&B. In addition to medicine and science, he is interested in history, economics, and writing.

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