The financial cost of saving a life: should it matter?

BarryD

One eyed Jack wrote: »

I stand by my original assertion that while I can empathise with these people's suffering, I feel that the costs of the treatment are far too high to be considered a cost effective treatment. That same €33m could have been better utilised in other areas of the healthcare system that are in much greater need of reform.

I'm inclined to agree and whilst I'm sure the half dozen people currently involved will be deeply grateful, you'd have to think there's a touch of PR about this. The equivalent amount of money could have been spent on say, home care or providing basic ambulance cover in more rural parts or many other health areas that would potentially benefit a far greater proportion of the population. But that wouldn't have been 'sexy news' - it would have hardly hit the public's attention at all.

And that's leaving aside a raft of reservations about the price paid and profits made by the pharma sector.

Capt'n Midnight

RobertKK wrote: »

Alexion didn't have to develop the drug Soliris, it cost a lot of money to get it to the stage where it could be marketed, a market that is very small.
The price of the drug reflects the cost combined with the small market for the drug.

Companies will avoid rare diseases or new types of treatment if they believe they are not worth it.

That's why we have research programs in universities.

There's lots arguments about how to fund drug research. The clincher for me is that even with Hollywood Accounting to channel as much spend as possible through R&D for tax reasons most companies still spend a lot more on marketing.


I'm tired and tired of hearing the "Drugs are expensive because they cost money to develop" argument. R&D barely hits 16% of income.

http://www.bbc.com/news/business-28212223
In 2013 Big Pharma spent $98.3bn on marketing and declared a profit of $89.8m for a total of $188.1bn
The amount claimed for R&D was a much smaller $65.8bn.


At present US industry spends about $3Bn on all university research and the Federal Government about $30Bn. Imagine what you could get for that $188.1 Bn

There's also the billion dollar fines and that's just for the US. In case you thought they'd improve GSK were fined $490m for bribery a few months ago in China.


Final quote "Unlike other sectors, brand loyalty goes out the window when patents expire."

Turtwig

BarryD wrote: »

I'm inclined to agree and whilst I'm sure the half dozen people currently involved will be deeply grateful, you'd have to think there's a touch of PR about this. The equivalent amount of money could have been spent on say, home care or providing basic ambulance cover in more rural parts or many other health areas that would potentially benefit a far greater proportion of the population. But that wouldn't have been 'sexy news' - it would have hardly hit the public's attention at all.

And that's leaving aside a raft of reservations about the price paid and profits made by the pharma sector.

I don't think it's necessarily PR. I'd say a bit of it is psychological. If given the choice between shooting one person in the head or randomly poisoning a food ingredient that will possibly kills hundreds. I'd say many people would opt to poison the food and not see who actually dies rather than shoot one person in the head. This way people will undoubtedly die but it's unclear as to who dies as a direct result of your decision. There's no specific person on your conscience. This drug will save the lives of ten people but it's not clear who or where the casualties will be from spending the €33 million. However if the €33 million wasn't spent it'd be fairly obviously who was let die.

RecordStraight

Capt'n Midnight wrote: »

Final quote "Unlike other sectors, brand loyalty goes out the window when patents expire."

That should tell you exactly why patents are important.

I suggest you put your money where your mouth is and put all your wealth into drug research in a company that spends no money on marketing - surely you will make a fortune?

CruelCoin

conorh91 wrote: »

Should life-saving drugs be denied if they cost too much? Can we put a price on life?

Yes and yes.

I dare say you could save more than one person a year with €400k.

Resources are limited. Efficiently run, the system will try to maximise output.

It's tragic for him, sure, but you cannot justify that kind of money.

JohnBee

As stated before but perhaps not in economic terms, most countries are able to identify what is termed "willingness to pay" thresholds. What these represent is the amount individual tax payers value a "quality adjusted life year" or QALY. A QALY is an indication of quality/life extensions given by a treatment. Thus a balance is struck between cost and benefit which enables health economists who have fixed budgets to get the most improvement in health for the WHOLE nation, not just one person. That cost varies, but citizens of the USA value this at somewhere between 60 and 90 thousand US dollars whereas in the UK, citizens value a QALY at 30k sterling.

Yes drug companies make a profit, but why is that a bad thing? When drug companies make a profit, then they attract investment which enables them to improve and develop new drugs. That is how drug development works. Saying that this is wrong is a very immature worldview. Relying on government funded research alone to fund drug research would be notoriously underfunded, and likely inefficient and not as effective.

the nikkei is rising

It makes me genuinely angry that the government won't step in to defend a tax payer who is being taken to the cleaner by vulturous pharmaceutical companies, they'll bail out their pals in the banks, send 400,000 to Africa to a country were people can't make the connection between eating raw monkeys and contracting Ebola and give Jacintha and her 10 kids 18 years or free education they'll never use and money for airmax runners on top, the working middle are the victims again when they should be first priority, the system this man is paying for and had paid for all his working life is failing him and nobody will do anything about it.

bjork

the system is so strapped for cash
3.7K for 1 Christmas tree
http://www.independent.ie/irish-news/hospital-spent-37k-on-trees-for-christmas-30969262.html

Over the past number of days, University Hospital Limerick (UHL) has had the highest number of patients on trolleys with 42 patients in the hospital’s emergency department on trolleys yesterday morning.

Records released by UHL yesterday confirm that it spent €3,714 on three Christmas trees in December including a spend of almost €3,000 on one 30ft tree.

Lau2976

The government refusing to pay for certain medications isn't a new thing unfortunately. I know a family who foot the bill of 4300 monthly for medication because they were €34 over the limit. Mediation that a 10 year old would die without. So this does not shock me tbh.

I find it hard to believe that there is no competition for this drug as there is for others.

RecordStraight

bjork wrote: »

the system is so strapped for cash
3.7K for 1 Christmas tree
http://www.independent.ie/irish-news/hospital-spent-37k-on-trees-for-christmas-30969262.html

Over the past number of days, University Hospital Limerick (UHL) has had the highest number of patients on trolleys with 42 patients in the hospital’s emergency department on trolleys yesterday morning.

Records released by UHL yesterday confirm that it spent €3,714 on three Christmas trees in December including a spend of almost €3,000 on one 30ft tree.

3k doesn't seem much to boost the morale of staff, patients and visitors tbh. Where do you draw the line?

RecordStraight

Lau2976 wrote: »

I find it hard to believe that there is no competition for this drug as there is for others.

The exact reason that there is no competition is because it is so hard to make money out of medicine.

bleg

There's a whole field of research on this called pharmacoeconomics.

It should be left to them to decide whether a treatment is for the greater good, not people pulling on heart strings.

Saying that, if I was in his situation I would do the exact same.

bjork

RecordStraight wrote: »

3k doesn't seem much to boost the morale of staff, patients and visitors tbh. Where do you draw the line?

It cost Ennis €89 to do the same thing
I don't know, where do you draw the line
50 people on trollies?

RobertKK

Capt'n Midnight wrote: »

That's why we have research programs in universities.

There's lots arguments about how to fund drug research. The clincher for me is that even with Hollywood Accounting to channel as much spend as possible through R&D for tax reasons most companies still spend a lot more on marketing.


I'm tired and tired of hearing the "Drugs are expensive because they cost money to develop" argument. R&D barely hits 16% of income.

http://www.bbc.com/news/business-28212223
In 2013 Big Pharma spent $98.3bn on marketing and declared a profit of $89.8m for a total of $188.1bn
The amount claimed for R&D was a much smaller $65.8bn.


At present US industry spends about $3Bn on all university research and the Federal Government about $30Bn. Imagine what you could get for that $188.1 Bn

There's also the billion dollar fines and that's just for the US. In case you thought they'd improve GSK were fined $490m for bribery a few months ago in China.


Final quote "Unlike other sectors, brand loyalty goes out the window when patents expire."

Look at the Hep C sector.

Gilead Sciences bought Pharmasset back in 2011 for over $11 billion because they had an interesting drug that showed signs it could cure Hepatitis C.
Gilead had to carry that cost plus the cost of development.
Here is what Reuters said at the time:
http://www.reuters.com/article/2011/11/21/us-gilead-pharmasset-idUSTRE7AK0XU20111121

(Reuters) - Gilead Sciences Inc (GILD.O) struck a deal to buy biotechnology company Pharmasset Inc VRUS.O for about $11 billion in a huge and risky bet on the next generation of hepatitis C treatments.
Gilead, the world's largest maker of HIV drugs, will pay $137 per share for each Pharmasset share, an 89 percent premium for a company with no significant marketed products.

Yes that worked out great for Gilead but they had to take that risk to get to where they were last year when the drug finally went to market after jumping through all the hoops along the way, the drug is a game changer in the treatment and curing of hepatitis C, but then in the last few months what happened?
A rival company Abbvie got their Hep C drug approved, not as good as Gileads so what do they do?
They start a price war with Gilead by doing a deal with a drugs distributor. This brings down the share price of all the drugs companies involved in this area.
So Gilead had their earnings report earlier this week, they had amazing results due to their Hep C drug, but announced they were going to discount their drug, so while the financial results were amazing, the shares fell 10% on the news.
Gilead had already heavily discounted the drug Sovaldi before any price war for poorer countries.

Do you think a university or government was going to pay what Gilead did for Pharmasset? It is private and stock exchange listed companies where the real game changers in health are.

Leaving things to the state or universities to do would be a disaster.
It is investors in companies who help fund new treatments and cures, but it is a high risk area especially in biotechnology, and I don't believe governments or universities would be allowed to take the same risk as these companies.
Imagine if a government pumped €500 million into research and trials and it ended in failure?
People would be saying, we should leave it to pharma and biotech companies to do this instead of wasting our money.
If they fail the bill isn't left with taxpayers, it is the investors.

RecordStraight

bjork wrote: »

It cost Ennis €89 to do the same thing
I don't know, where do you draw the line
50 people on trollies?

You think 50 people on trollies can be cured with 3k?

Of course, if they didn't have the Christmas trees, you'd have another bunch of drones complaining. Sometimes you just can't win.

The Corinthian

Spend 400k so that one man may live and that is 400k that will not be spent on treatment to potentially save the lives of ten others. Will you let ten die because you feel bad for this man?

Unfortunately we live in a World where scarcity is a fact of life - it's what economics is designed to manage after all - and if resources are scarce, then you need to employ them in a manner that will cause the greatest good, or the least harm. Blubbering that won't someone think of the children isn't going to change that or wash the blood off your hands when your act of charity dooms ten others.

As to the cost of such drugs, that's another unfortunate fact of life. I had a pharma client who was selling a drug they'd developed that cost 700k per treatment. Why that much? Suggesting it's all corporate greed (while no doubt a factor) would be an idiotic presumption. In reality developing drugs takes a lot of time and a lot of money and if you can't make that money back then it does not make sense to do so - this has been the problem with antibiotics in recent years; their lifespan is often so short, before they become ineffective, that the pharma companies can't recoup their investment in R&D, so they don't bother. Hence the crisis there.

Or, if you feel so strongly about it, you could go off and do a primary degree, masters and Phd in the field. Maybe do a few postdocs too. Pay for them all and forego a real salary during the 8+ years you're studying. Then to make these drugs more affordable, you can accept the same level of salary you'd have made if you'd just gotten a job as a butcher on leaving school.

No? Didn't think so.

Turtwig

bjork wrote: »

the system is so strapped for cash
3.7K for 1 Christmas tree
http://www.independent.ie/irish-news/hospital-spent-37k-on-trees-for-christmas-30969262.html

Over the past number of days, University Hospital Limerick (UHL) has had the highest number of patients on trolleys with 42 patients in the hospital’s emergency department on trolleys yesterday morning.

Records released by UHL yesterday confirm that it spent €3,714 on three Christmas trees in December including a spend of almost €3,000 on one 30ft tree.

Anything done to staff and patients, especially those under 18, that helps provide the illusion of the hospital being something other than a cold miserable place is to be welcomed imo.

Honestly you can't win. On the one hand people complain about the lack of vibrancy. Especially in kids wards. Then when something is done to add color people get irked at the cost.

RobertKK

It should be noted Alexion did do trials with their Soliris drug for the treatment of arthritis, which has we know is a disease a lot suffer with.
That trial failed, instantly the market for their Soliris drug went from potential millions of people to treat with Soliris to just thousands of people to treat.
Here is a good article on Alexion.
http://www.forbes.com/sites/matthewherper/2012/09/05/how-a-440000-drug-is-turning-alexion-into-biotechs-new-innovation-powerhouse/

I think people should read that article I posted, it shows how Alexion as a company was on death's door, about to be another failure in the biotech world.
After failure after failure, they thought there was no profit to be made in rare diseases - a company won't survive with losses. How they worried there was not enough people for a clinical trial of Soliris when they eventually went down the road of treating a rare disease, and the worry it might kill patients when taken off it, by making the disease more aggressive.

We should celebrate companies like Alexion, not think what a terrible company they are interested in profit.
These people save lives by the risks they took.
Just read to how they got to where they are now and for me, these are the type of people we need, not ones we should despise.

challengemaster

Kristopherus wrote: »

Its the manufacturer of the drug that is holding the HSE to ransom. They could, if they wanted, provide it for nominal cost and make their profit from the resulting goodwill.

And how exactly do they recoup the likely billions of dollars/euros spent on R&D and clinical trials? Each time they try re-purpose the drug for another disease they incur significant R&D and clinical trial costs.

forbes 2012 wrote:

Alexion, with 1,100 employees, is a multinational pharmaceutical company with offices in more than 30 countries–but only a few thousand patients the whole world over.

http://www.forbes.com/sites/matthewherper/2012/09/05/how-a-440000-drug-is-turning-alexion-into-biotechs-new-innovation-powerhouse/


People seem to be ignoring the fact that other countries such as New Zealand also won't subsidize the drug because the cost is too high.

RecordStraight

challengemaster wrote: »

And how exactly do they recoup the likely billions of dollars/euros spent on R&D and clinical trials?

Tssssk...he already explained how: with goodwill.

The_Captain

Personally I don't think we should pay those kind of rates for new drugs, so the pharmaceutical companies will lose money on researching and bringing new drugs to market, will stop doing it and we'll all die from otherwise treatable diseases.

Jesus, we literally live in a country where the standard of healthcare you receive, and your chances of surviving, are directly correlated with income levels, to the point where we have special hospitals only for rich people.

Capt'n Midnight

RobertKK wrote: »

Do you think a university or government was going to pay what Gilead did for Pharmasset? It is private and stock exchange listed companies where the real game changers in health are.
...
Leaving things to the state or universities to do would be a disaster.
It is investors in companies who help fund new treatments and cures, but it is a high risk area especially in biotechnology, and I don't believe governments or universities would be allowed to take the same risk as these companies.
Imagine if a government pumped €500 million into research and trials and it ended in failure?
People would be saying, we should leave it to pharma and biotech companies to do this instead of wasting our money.
If they fail the bill isn't left with taxpayers, it is the investors.

The HSE spends €1,800 million on pharma every year.


http://www.reuters.com/article/2015/02/02/us-usa-budget-medicare-idUSKBN0L61OW20150202 Obamacare will be spending $82.5Bn on Part D drugs. That's more the entire buget for University research. And Obama is talking of spending $215 on genetic treatments. Also the RRP of Sovaldi would cost the US $200Bn

For that sort of money you have to question whether it should go to organisations that only spend 16% on R&D and have huge ethical issues re convictions for bribery, false claims of effectiveness and who routinely threaten to withhold life saving treatments in the interests of profit OR you could fund public universities who will spend a lot more than 16% of funding on research and you could keep them under control because you can pull the funding.

Perhaps big pharma could be turned into Design Houses. Where they do the R&D for cost plus paid for by Governments / WHO / Insurance Companies and then to benefit all of humanity those drugs could be licensed out to all manufacturers.

Because the current system of extorting payment by withholding treatment is killing people. And it's sickening to think that over 40% of that payment is for marketing and profit.

RecordStraight

Capt'n Midnight wrote: »

Because the current system of extorting payment by withholding treatment is killing people. And it's sickening to think that over 40% of that payment is for marketing and profit.

Yeah, it's sickening that people might actually make some money having risked their hard-earned cash on the slim chances of finding cures for diseases and getting a return in the few years between approval and the patent expiring.

And of course colleges are beyond corruption, particularly if you start throwing tens of billions at them...and governments have a great track record of running enterprises, don't they?

Mad stuff.

UCDVet

1.) There are a limited number of resources. It is impossible to give everyone the best of everything.
2.) Some preventable illnesses/deaths are more expensive than others.

Given both of these, if the goal is to minimize the total number of deaths (or suffering) it makes the most sense to save lives in the most cost effective way possible.

Spending 600k euro to extend the life of an elderly man by 10 years isn't nearly so good of an investment than spending 600k to save the life of a 100 with easily preventable illnesses that will extend each of their lives by an average of 15 years. 150 years verse 10 years.

Until we have unlimited resources, this will always be the case. If everyone got the best health care possible, even with a 100% tax rate, we couldn't afford it. That's the harsh reality of the situation.

bjork

Boo hoo, the poor limited resources bleat


Look at this sh1t

In total, 41 overpayments were of amounts of €10,000 or more, the worst being:

- €191,225 to an employee in an unspecified position who continued to receive full pay while on reduced hours from 2002 up to their retirement in 2010. A repayment schedule of 3% of the pension was agreed but the audit states: “According to this repayment schedule, it will take approximately 561 years to fully repay the amount.” It said the repayment deal amounted to a “de facto write-off”;

- €85,865 to a medical scientist from 1999 to 2003 when he was paid for working full hours even though he was out sick. His sick leave had expired so he was due no pay. The possibility of legal action through the civil courts is being examined but the case is not yet with the HSE legal department:

- €55,529 to an employee whose hours were reduced but whose salary was not. The audit says repayment has commenced;

- €46,373 to an employee who resigned in October 2008 but continued being paid until June 2009. The audit says the money is being repaid;

- €34,373 to a woman who continued to be paid while taking unpaid leave, parental leave, and a career break after her maternity leave. The audit says that repayment is “due to commence”;

- €33,841 overpaid to a staff nurse who was wrongly paid as a public health nurse. The overpayment was written off after the intervention of the Labour Relations Commission.

http://www.irishexaminer.com/ireland/561-years-to-return-190k-hse-overpay-311042.html


Boom over 2.5 million wasted by idiots

RecordStraight

bjork wrote: »

Boo hoo, the poor limited resources bleat

You think that this type of bureaucratic waste and inefficiency would be eliminated if the HSE started paying for every single treatment for every single patient, regardless of cost?

If not, why mention it? It's not relevant. Big organisations can be wasteful, it's hardly a secret.

Kurtosis

bjork wrote: »

Boo hoo, the poor limited resources bleat

Sure there is wastage/inefficiency in the system, but this is finite, not a magical source of unlimited funds. Plus even if savings are made by reducing wastage, the question still stands as to where to spend this to get the most benefit.

bjork

RecordStraight wrote: »

You think that this type of bureaucratic waste and inefficiency would be eliminated if the HSE started paying for every single treatment for every single patient, regardless of cost?

If not, why mention it? It's not relevant. Big organisations can be wasteful, it's hardly a secret.

I thought the excuse was limited resources? not too limited when it comes to fcuking up it seems

Not the first instance, won't be the last
but there's no money when it comes to providing treatment, which is their core "business"

RecordStraight

bjork wrote: »

I thought the excuse was limited resources? not too limited when it comes to fcuking up it seems

Not the first instance, won't be the last
but there's no money when it comes to providing treatment, which is their core "business"

So your theory is that they are deliberately wasteful so as not to pay for everybody's treatment?

Turtwig

bjork wrote: »

Boo hoo, the poor limited resources bleat


Look at this sh1t

In total, 41 overpayments were of amounts of €10,000 or more, the worst being:

- €191,225 to an employee in an unspecified position who continued to receive full pay while on reduced hours from 2002 up to their retirement in 2010. A repayment schedule of 3% of the pension was agreed but the audit states: “According to this repayment schedule, it will take approximately 561 years to fully repay the amount.” It said the repayment deal amounted to a “de facto write-off”;

- €85,865 to a medical scientist from 1999 to 2003 when he was paid for working full hours even though he was out sick. His sick leave had expired so he was due no pay. The possibility of legal action through the civil courts is being examined but the case is not yet with the HSE legal department:

- €55,529 to an employee whose hours were reduced but whose salary was not. The audit says repayment has commenced;

- €46,373 to an employee who resigned in October 2008 but continued being paid until June 2009. The audit says the money is being repaid;

- €34,373 to a woman who continued to be paid while taking unpaid leave, parental leave, and a career break after her maternity leave. The audit says that repayment is “due to commence”;

- €33,841 overpaid to a staff nurse who was wrongly paid as a public health nurse. The overpayment was written off after the intervention of the Labour Relations Commission.

http://www.irishexaminer.com/ireland/561-years-to-return-190k-hse-overpay-311042.html


Boom over 2.5 million wasted by idiots

If you take any organisation inefficiency and errors are expected. The key thing is keeping these errors (and possible incidences of fraud) to a minimum. Hence the purpose of audits.

Like others, I cannot fathom the relevance of this to the discussion at hand. Even if the HSE was 1% efficient how would that mean they should spend money on the most inefficient treatments?

Basically what you did is point out flaws and inefficiences in the system and then you want to use that to justify another inefficent use of spending.