Zytiga, also known as abiraterone, is taken once a day as a single dose of four tablets and costs 2,930 pounds ($4,600) for a 30-day supply.

The drug was hailed as a significant advance by cancer doctors after a clinical trial showed it extended the lives of patients with advanced prostate cancer by an average of 3.9 months.

It was quickly approved by U.S. and European regulators last year, but Britain's National Institute for Health and Clinical Excellence (NICE) said it did not provide enough benefit to justify the high cost, even with a discount offered by J&J.

Dar started down the right path by asking who's paying, but there's more to it than that. There's questions of age,

The drug was hailed as a significant advance by cancer doctors after a clinical trial showed it extended the lives of patients with advanced prostate cancer by an average of 3.9 months.

I'd really like to hear your thoughts on this one (or everyone's thoughts, I guess). Seems a bit odd, honestly.

It does? Why? If you're weighing benefits of extending life, then an elderly person will probably see dramatically less benefit from living longer than someone that's younger. Whether you measure that in economic output, the relationships that they have (if you're 93, people are probably not going to be surprised to hear that you're dying but at 43 that's a different picture), etc. From a purely "rational" economic argument, younger people will repay more of the money spent on them through the work they will perform than older people.

In the US, we spend dramatically more on health care for the elderly than we do any other demographic (I'd need to dig for my stats, but I want to say it's like 2/3 of all spending for a person tends to occur in the last decade of their life). And while I want my parents to hang around a long time as much as anyone else, it can be worth asking if we're attaching too much value to extending their lives when it's so expensive.

As I said before, that's fairly cold calculus. But we can spend a small fortune keeping people alive when perhaps that's not even what's best for them. My grandmother was basically in a different universe for the last 5-10 years of her life and she had huge medical bills for full-time care, cancer treatment, diabetes, etc. And it was hugely painful to watch a vibrant, active woman basically waste away with limited recognition of what was going on around her.

It's good that we value life highly. But we often appear to value it without limit or at least without discussing limits. And that's just not real. We send soldiers off to war knowing that some will never return and others will return mentally or physically broken. And we argue endlessly about whether it was worth it. We probably should do more of that type of thinking about when we think it appropriate to extend life as well. Right now, we've a pretty generic answer for that side of the equation.

Is $18K too much to pay to (maybe) extend a life by 4 months? I can understand people are upset by the decision not to cover the drug, but I can't decide how I would place a dollar cap on any medical care.

I'm sure that the esteemed RSP denizens will have all the answers, so enlighten me.

Would the answer change, I wonder, if we found that these pills only cost the drug manufacturer about $2.80 to produce that four month supply, and even integrating research and development costs into the cost of the pill, only ran than up to, say, $50 or so...but they charged $18k because they knew they could get away with that.

Ah, alright. I don't necessarily agree with assigning value based on economic potential but that's a perfectly reasonable position for someone that does.

I'm certainly no big defender of big Pharma, but this isn't fair. A cheap drug costs them something like $500 million to develop and the R&D costs for some range over $1 billion spent over a decade. On an episode of West Wing, one character puts it nicely in perspective (my paraphrase follows) - "The second pill cost them $1.50. The first cost them $800 million."

And that's the way it's gotta be or you don't get new drugs. Either they get a way to pay back the massive R&D investments they make or we won't have new medicines. Further, they have to make that money back before the generics can ship or they won't be able to do so.

If you want to change that, then there's lots and lots of things that need to be changed or there won't be a pharmaceuticals industry that does R&D.

I don't know what makes some new drugs 10 or more times expensive than other new drugs, but there are 4 possible reasons i can think of:


1 - They are much much more expensive to produce (very unlikely to cover the difference)

2 - They cost 10 times as much to develop

3 - They have the same development and production costs, but only 1/10th the potential market

4 - The company is price-gouging.

People tend to assume number 4, but a combination of 2 and 3 seems more realistic

I had a doctor friend tell me once that only 1 in 6 drugs that make it to human trials will eventually make it to the public. And for every drug that makes it to human trials, five don't.