TOPIC:

Thought the same thing, zhuk.

I had these dreams of mixing sofosbuvir and Mike's male pattern baldness medication and capsulating it. Obviously not a complete solution but a significant number of male hepers are bald so it would be a start.

On a more serious note it seemed too easy so I did a bit of checking and apparently the active ingredient in Daraprim is well out of patent. But not a very big market so not worth any competitors catering to until Turing pushed the price though the roof and restricted distribution which then made it worthwhile for ExpressScripts to smash the market with a $1 capsule to avoid paying Turing.

And back more on topic, I found this article about understating of U.S. Hep C numbers.

onlinelibrary.wiley.com/doi/10.1002/hep.27978/abstract

I wonder how many similar type groups are excluded in other countries counts?

I know in Australia it is a reportable disease but how do we count - the total reports? Or do we use a different set of figures as we seem to be a bit vague about how many have it? I've seen anything from 200k to 270k quoted although the most common figure seems to be about 230k.

G

Hi,

There is an article by D. Lavanchy (Feb 2011, Journal of Clinical Microbiology and Infection, 17:107-115) which gives a breakdown by country of the numbers of people infected by Hep-C (Table 1). The total comes to 158 910 617. Or roughly 160 Million people. The figure for Australia is 227 331, or roughly 230 Million, which agrees with the figure often quoted elsewhere.

www.sciencedirect.com/science/article/pii/S1198743X14616487

For the impatient, this shows USA: 5 367 834; UK: 659 032; France: 814 281; Germany 620 168; Spain: 906 340; Italy: 1 923 136, Russia: 5 796 498; Japan: 3 058 008, for example)

Someone at hepcoalition.org used these figures to calculate, by country, the total numbers of people excluded by the Gilead "Voluntary Licence":

www.hepcoalition.org/IMG/pdf/countries_excluded_gilead_s_vl.pdf

The total comes to 73 087 095, or roughly 73 Million. If we set aside China (29 791 212, or roughly 30 Million), which has not accepted Gilead's patents and can therefore manufacture as much sofosbuvir as it likes, this leaves roughly 43 Million infected people who live in countries that are at the mercy of Gilead's pricing monopoly.

If we then take Gilead's price of $84 000 per treatment, we get a grand total of 84 000 x 43 000 000 = $ 3 612 000 000 000, or roughly $ 3.6 TRILLION as the cost to treat everyone in the "developed" world with Hep-C.

If we take a price of $ 1 000 as the baseline cost of a treatment under Gilead's voluntary licence, then the cost to treat everyone else outside of China (160 - 30 - 43 Million = 87 Million) comes to $ 87 000 000 000, or $87 BILLION.

According the recent analysis by US senators Wyden and Grassley (see full report, page 2, fixhepc.com/blog.html), Gilead have sold $26.6 Billion worth of sofosbuvir in the 21 months up to October 2015. Given that they paid "only" $ 11 Billion to Pharmasset to acquire the rights to the molecule, they have already recouped their costs and made an enormous return on their investment.

Also according to Wyden and Grassley, of the $ 26.6 Billion sales, $20.6 Billion was to US customers. Now, 20 600 000 000 / 84 000 = 245 000 treatments. And 245 000 / 5 367 834 = 0.045. In other words, only 4.5 % of Americans with the disease have been treated.


Of course these calculations are only estimates.

But let's carry on and do the same kind of estimate for outside of the US with the remaining $ 6 Billion. We know that the europeans pay less because its harder to screw a foreign government than an american insurance company. So let's guess a an average price for europe and the rest of the world of $ 60 000. This gives 6 000 000 000 / 60 000 = 1 000 000 or 1 Million people. Now 1 000 000 / 43 000 000 = 0.023. In other words, to date, only about 2.5% of people in the "developed" world have been treated.

So with all the big numbers out of they way, we can now see that Gilead are making a shit-load of money (which we all knew already by now), while still leaving the vast majority of people untreated.

Yours,

Absolutely speechless.

Great job number-crunching, Vororo. What was already obviously an obscenely small percentage of treated patients just becomes all the more stark under that spotlight.


What Gilead would no doubt call "untapped revenue potential"

Thanks Zhuk.

But I stopped just a bit too soon. Setting the absolutely criminal price aside for a brief moment, with just a bit more math we can say that at the present rate it will take about 22 years to treat all 5.3 Million Americans with the disease, and about 40 years to treat the rest of the "developed" world.

When will Gilead's patents run out? They're normally good for about 17 years, or maybe 20 with some creative thinking?

Not good news, for what is supposed to be a break-through treatment.

You're basing your timescale on hepc elimination on static figures, surely, Vororo? In my country (the UK) the money that's been made available will barely maintain the figures taking into account year-on-year new infections.

Oops, I made a mistake. I forgot that the percentage treatment rates are for 21 months of sales. So in fact, for the USA the rate of treatment is more like 2.6% per year, and for the rest of the world it is more like 1.4% per year.

Sorry for the mistake.

So... setting the absolutely criminal price aside for a brief moment, with the right math this time we can say that at the present rate it will take about 38 years to treat all 5.3 Million Americans with the disease, and about 71 years to treat the rest of the "developed" world.

As before, Gilead's patents could be good for from between about 17 to up to 20 years. And of course, the price will fall rapidly once the patents expire and generics will flood the market. But assuming my math is right this time, we are still looking at only about 17*1.4 = 24 % of americans and getting treated if Gilead continue to have things their way, with the rest having to wait until Gilead's patents expire.

And the calculation looks even worse for the rest of the "developed" world.

zhuk wrote: .....What Gilead would no doubt call "untapped revenue potential"

And they DO call it things like that. Just how feral do obscene entities such as Gilead Sciences have to get before somebody with power and influence rains on their parade?

Hi Alsdad,

Yeah, sure, based on static figures. I was really just trying to work out for myself what percentage of people who are currently identified with the disease are actually getting treated now, or who actually have any hope of getting treated in the next few years, taking into account current prices.

Obviously, there are still new infections every year, and people are dying every year, so the reality is probably worse than my quick estimates. So you're right, despite the best efforts of national health services, we are going nowhere fast.

Despite the fact that a perfectly good treatment now exists.

Well,
If Hillary Clinton wins next year, she may be able to exercise some executive action, because she won't be able to get anything through the Republican majority in Congress. If a Republican wins in November, Gilead will be secure in its predatory pricing.
The way I see it, if someone doesn't have the $5000 to $8000 needed to go to India or can't work out a direct import for half that, they probably qualify for patient assistance somewhere. That "treatment exodus" of dollars will come straight out of Gilead's pocket. Up until now, they have had everyone by the short hairs. This kind of market pressure is what is needed right now. There will still be a lot of people caught in the middle, but the medical tourism business is going to get a big boost. and Gilead's revenue is going to take a substantial hit. The insurers should be buying tourism packages for their clients. They could pay for 12 people to get 12 weeks of Twinvir for what they are paying for my 8 week Harvoni treatment alone.

Time will tell.
Mike

Thanks Mike,

Yeah, its a crazy world. Take a holiday and get cured into the bargain. Probably not good for global warming if everyone has to fly to Australia or Bangladesh, or take a bus to Canada to get treated... But that's better than filling the pockets of Big Pharma,

Thanks 2b and GAJ for the links and especially Vororo for the links and number crunching.

And Tina, a special thanks to you for your link.
www.canberratimes.com.au/comment/big-kar...20151202-gldg59.html

I had a personal little debate battle with someone a year and a half ago on this very issue and I hope the #@(*@! remembers me and my predictions. I also wonder if he's not the person at Gilead that got fired. (Mr. "he's no longer with us" who's name I'm going to be going back looking for later to see if I can determine if I'm correct.) The person I and others were debating took the handle "pharmaguy" and made the mistake of using the personal pronoun "we" when he got worked up, seemingly outing himself as a Gilead exec. (I still can't prove that.)

Read the comments in this article from the Wall Street Journal Blogs dated July 11, 2014.
As is my custom, I used my real name in the comments. (click "view all comments")
blogs.wsj.com/pharmalot/2014/07/11/gilea...-over-hep-c-pricing/

One clip I'll highlight here:

3:48 pm July 15, 2014
Kevin Hilde wrote:

Pharma Guy, you either missed my point, or you're not really understanding Capitalist Theory properly. In true capitalism no monopoly is possible. Only under the coercive power of the state can monopolies be sustained. That's what you're defending, not true capitalism.

Again, even I as a die hard libertarian am not absolutely anti intellectual property. But I certainly do recognize the arbitrary nature of IP rights and their durations. If you're curious, google "Mickey Mouse Copyright" . In Donald Passman's book "All You Need To Know About The Music Business" several times he points out how Copyright laws have been manipulated by the powerful for their own advantage.

It remains true that when government creates levers of power the powerful get their hands on the levers. Regulatory Capture is a growing problem.

To be sure, the US does not have remotely the problems that Russia and China have in that regard, but we are clearly moving that direction, away from true Capitalism, with the EU leading us by a couple body lengths. It's sad, but authoritarianism is currently winning the political battle, and we're headed for an awful mix of socialism and fascism. We'll end up with authoritarian battles swinging back and forth between socialist and fascist with the two gradually ratcheting us away from our constitution and true freedom.

Whether you realize it or not, the pricing decisions of Gilead will play into the hands of the socialist side of the authoritarians. Gilead has a fantastic product. But rather than being happy with very healthy margins they are pricing this drug in such an exorbitant manner that it will bring a backlash that could destroy the industry.

Patents are important to protect IP, the problem is they produce a monopoly power that is open to abuse.

The world at large needs a mechanism to bring the pendulum back towards the centre.

To swing it all the way from monopoly to "ignore the patent" would be just as problematic as leaving it where it is.

The bottom line is that Sofosbuvir cost $375 million to develop. That's a lot of cash, and a lot of risk. The Pharmasset investors got a great 30 x return, Gilead have got a great (almost risk free) 3 x return in under 3 years. Everyone who took a risk has been paid back in spades and now it's time to provision the world with this cure, and for the next Pharmasset to develop the next great antibiotic.

Big Pharma has gotten fat and lazy - consider statins - we have 9 different ones - that's one great new idea and 8 "me too" clones. Almost all the me to clone money could have been better spent on new ideas.

We need more innovation and less low risk sequels.

To make that happen we need to incentivise it, and the best way to do that is to adopt drug purchase/subsidy policies that look like "we need 2 good solutions to this problem" - who's offering the best prices? New Zealand do exactly that and enjoy medication prices 1/8 what Australia pays and very similar health outcomes.

Australia is idiotic in this regard - we do not need all the statins to be subsidised and doing so removes price competition. It's about time we got a clue and put our tax dollars to better use incentivising new blockbusters, not yet another sequel.

Thanks, khilde,

Just read the "full comments" exchange on your post. I gotta say, y'all got some real tough-talking red-necks in the US!

You have my full respect for trying to argue some kind of basic humanity back into guys like your "pharma guy", who comes across (only slightly) as a more articulate version of Martin Shkreli (he of the soon-to-go-belly-up Turing Pharmaceuticals fame).

It would be very funny (not) if "pharma guy" does indeed turn out to be a former employee of Gilead. But certainly worth forwarding all details directly to the Hilary Clinton camp if you every manage to make the link concrete.

Well, shit happens. And sometimes even good shit might happen.

We live in hope.

One quibble on Dr. Freeman's post .... not three years .... Two.

The FDA approved Sovaldi (sofosbuvir) on Dec 6, 2013

For those in Australia through EU time zones, the two year anniversary date is ... tomorrow.

EU approval was Jan 17, 2014 and approval in Japan was not until Mar 26, 2015.

Harvoni approval dates were:
US ... Nov 12, 2014
EU ... Nov 18, 2014
Japan ... July 3, 2015

We should throw an online SCREW GILEAD party!



My, how time flies.