Scott Gibson: Better life through chemistry comes at confounding price

We are living in an extraordinary time of advances in medical therapy.

Immunotherapy is revolutionizing cancer treatment, with control and even cures for tumors that would have been rapidly fatal only a few years ago. We now can cure chronic hepatitis C, one of the leading causes of liver failure, in more than 98% of cases.

Recently, two new drugs won FDA approval for treating Alzheimer’s in an early stage.

The benefits are, sadly, only so-so, for the drug only slows the relentless progression of the disease, and the price tag — $78,800 per patient — is eye-popping. Still, it represents the best advance we have yet seen for the treatment of this common and devastating disease.

Perhaps most newsworthy, however, are two drugs on the market — and more coming soon — that foster significant weight loss. That’s the Holy Grail of the pharmaceutical industry.

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

Here, then, we have been blessed with substantial advances in some of the most common conditions in medicine — cancer, dementia, hepatitis C, diabetes and obesity. That’s clearly a cause for celebration, except for one thing: the cost.

I have already noted the cost of the Alzheimer’s medicine.

This drug is only indicated for people with early-stage dementia, so most Alzheimer’s patients would not be eligible. In spite of that, at the current cost for therapy, the bill would run roughly $160 billion for the more than 2 million qualifying Americans.

That would dictate a 21% increase in the entire federal Medicare budget.

One advantage is that the treatment, at least as currently studied, would be given only once. That could change, though, if future studies show benefit from repeat treatment.

The cost of cancer therapy has also shot up.

In 2000, the cost for new cancer drugs ran about $2,000 per month. By 2014, it had risen to $10,000 per month, and the increases have persisted since then.

New immunotherapy drugs have shown sometimes spectacular effectiveness, but the price tag is also attention-grabbing.

For example, Imfinzi, a drug used for some types of lung cancer, added, on average, 2.4 years of life. But it also added, on average, more than $100,000 to the cost of treatment, pushing it to a whopping $245,000.

The treatment for chronic hepatitis C is so good that if we were to treat all 2.4 million American with the illness, we could almost eradicate the disease. And the cost of treatment has fallen to $24,000 per patient, just a quarter of what it was running a few years ago.

Still, that’s $58 billion for a disease can cause cirrhosis of the liver and death, though only in a minority of patients. Not cheap, but in the long run, treatment would prevent cirrhosis and liver cancer for hundreds of thousands of patients and make the disease rare in the U.S.

The really big potential expense, though, comes with the treatment of obesity, which afflicts 42% of Americans.

The new medications, called GLP-1 agonists, provide up to 24% weight reduction in a year, similar to the effects of weight-loss surgery. They also treat diabetes, prevent heart attacks and stroke, decrease kidney failure, and improve symptoms of some types of heart failure.

Recent reports suggest they may even blunt cravings for alcohol and tobacco in addicts. The list of benefits is so long I would scarcely be surprised if they turned out to cure bad breath and baldness.

This class of drugs, which includes Ozempic and Mounjaro, work to decrease appetite. Remarkably, though, we don’t know why or how.

After years of trying without success to achieve weight loss by targeting appetite hormones, drugmakers succeeded accidentally with drugs designed to treat diabetes.

The problem again, of course, is cost.

The weight-loss effect of this class of drugs, the leading current examples being Ozempic and Mounjaro, only lasts while they are being used. Stop them, and weight comes back.

But the two drugs each cost about $14,000 per year. And competing drugs coming to market soon will likely cost about the same.

Americans currently spend about $60 billion per year on weight loss. If we were to treat all the obese people in America with these new drugs, the price tag would be over $2 trillion per year.

That’s half of what the U.S. spends on all health care. It’s more than the Defense Department and Medicare budgets combined.

Obviously, we won’t be willing to increase health care spending by 50%, or an added $6,5000 per person annually. At that price point, it’s more cost-effective to get surgical therapy for obesity, which costs about the same as a year’s worth of Ozempic and gives durable results.

These drugs have already created a battle. The amount of money to be made from them is staggering, and the drug companies will scrap for every dime they can get.

Insurance companies will try to restrict the number of patients who get them. But given their broad benefits, it will be a challenge to narrow the number of people who qualify.

I suspect that demand for these drugs will create a shift to lower prices, though how soon is tough to determine. No doubt people will travel abroad to get their supplies from countries with price controls.

The government, which now has the authority to bargain with companies for cost of drugs provided by Medicare, may eventually bring prices down. And me-too drugs will keep coming on the market, which could push prices lower even in the competition-resistant world of pharmaceuticals.

New medications will create widespread benefits, and sooner than we think. The fight between drug companies and those who pay — insurers and consumers — will be never-ending.

It seems almost inevitable that medical costs will rise. But if we get thinner, have less cancer, wave goodbye to hepatitis C and lessen the burden of dementia, we may well be willing to spend more for better and longer lives.

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