How should cures be priced?

[Flixy]

I think this is a pretty naive perspective (no offense).

Oh none taken, I deliberately posted it as a naive perspective. It's idealistic not realistic, and I am fully aware the world doesn't really work that way - but it'd be nice if it did.

Will read the rest of your long post and reply with more substance later.

[wiggin]

Wiggin, they may be asymptomatic currently. That will change for at least 25% of them. There are also the other issues caused by HepC, like diabetes, depression and other stuff.

But, sure, let's wait until the damage is done and not treat them before.

Regarding the guidelines: Who writes those and what considerations go into them? Because if they're also looking at the price of a treatment it's no wonder at all they are waiting for a case to become acute - at that point it basically becomes circular reasoning.

Khen, I think you don't really understand how medicine works. (This is not intended as a slight, just an observation.) There are all sorts of diseases and conditions where the first line response is 'watchful waiting' because intervention is not called for in the majority of cases. It might be compounded by the high cost or safety profile of a given intervention, but even in the absence of these pressures, a lot of the time physicians just observe the course of a disease until it requires an intervention. There are obviously important caveats - in principle it is ideal to intervene before substantial and permanent damage is done, but even then there are reasons to delay (for example, the great lengths that physicians go to delay implanting synthetic joint replacements even in the face of substantial deleterious effects on the patient's quality of life). But early stage HepC is not one of those cases.

As for the guidelines, they generally are put together with input from a lot of different stakeholders. Early guidelines tend to be informal ones developed on the basis of early clinical data, but more formal guidelines tend to be a combination of physicians organizations (e.g. the American Academic of X Specialty) with input from payers, patient groups, and regulators (especially regarding approved uses vs. 'off-label' usage). They evolve as clinical data becomes available - admittedly, sometimes too slowly for everyone's taste. Certainly price is one factor - it always is, even for relatively inexpensive therapies - but some very expensive therapies rapidly become the universal standard of care (at least in the US) if the data supports their use. In the case of HepC, since so many patients are asymptomatic and will not have substantial negative consequences from infection during their lifetimes, it makes sense to wait for some clinical manifestation for disease progression before acting.

Oh none taken, I deliberately posted it as a naive perspective. It's idealistic not realistic, and I am fully aware the world doesn't really work that way - but it'd be nice if it did.

Will read the rest of your long post and reply with more substance later.

I think the problem is that if medical therapies are developed with private capital, it's always going to work that way. There are certainly other models - government funding, philanthropic funding - but for various reasons these models tend to be for niches that are missed by the market and/or only for parts of the development process. I can imagine that other models are possible, and they may be superior in some ways. Short of a very comprehensive shift in how we advance medical technology, though, it's going to be very hard to do.