Hacker News Reader

Comment by byteCoder | Hacker News Reader

Since this was conducted under a research trial by the US government, the treatment did not cost me (or my health insurance) a penny.

I am told that the treatment and follow-ups cost the research program budget at least a million dollars per patient.

View on HN

An important example of the government's role in medicine.

Many research trials are privately funded, but run by the government for regulatory reasons. I don't know about this one.

Absolutely agreed.

This is a mind blowing amount. What could be the reason for such a high cost?

Cutting edge scientific research is expensive. I don't know why people expect advanced medicine to be cheap. Synthesizing or extracting complex proteins, using rare medical radioisotopes, medical scanners based on the most cutting edge engineering and physics... Almost no endeavor besides physics and medicine makes regular use of superconductors, antimatter (for PET scans), etc.

> I don't know why people expect advanced medicine to be cheap

Nobody said cheap. People (me included) actually expect immunotherapy to be expensive. A course of Perjeta/Herceptin can go to $188k (per [1]). But many are already outraged by this number. A course of Rituxan can be about $14k to the patient, and you could say it's dirt cheap compared to Herceptin, but it appears the cost to the manufacturer is $300 ([2]).

As for superconductors, antimatter, and all other sci-fi sounding things, the cost of an PET scan is about $7k, and of an MRI scan is less than half that, so that can't explain the million we're talking about here.

I think we simply became insensitive to hearing big numbers in the context of healthcare. The birth of my second son cost my insurance about $130k (they covered 90%, but I still had to fork out about $15k), and he didn't have any surgery, or anything major. So yes, I can understand $1MM for cancer treatment, but allow me to be mindblown all the same. I don't think $130k was reasonable for a delivery, and I don't think $1MM is reasonable for immunotherapy (which again, does not involve surgery).

[1] http://www.fiercepharma.com/regulatory/fda-approves-roche-s-... [2] http://consumersunion.org/outrageous-health-costs/cancer-dru...

I'm going to assume the lion's share of costs in something as routine as a regular delivery of a baby (i.e. no complications) is probably going to be: Hospital expenses and doctor/surgery costs. IMO paying thousands of dollars to surgeons is definitely justified. I have several doctors in the extended fam, some of whom are surgeons. One of my cousins is studying to be one. Its just fucking crazy how much effort is required to be a doctor (not to mention all the costs assosciated with the education itself). So personally, I think the labor costs of surgery are justified.

The hospital charges make sense too as you're under supervision by trained nurses and living in a room built with specialized equipment.

I had an appendectomy recently. Everything included (surgery, hospital charges, drugs etc.) came to ~ $55k. Insurance paid most of it and I was ultimately charged around $5k. With that in mind $130k doesn't sound unreasonable for a delivery of a baby.

> $130k doesn't sound unreasonable for a delivery of a baby

While I'm accustomed to hearing this kind of thing from the USA, know that for citizens of any other developed country, that is an absolutely absurd amount, to the tune of 10x or 20x the proper cost.

I've recently had friends in both Japan and Australia, hardly countries with poor healthcare, give birth and in both cases the cost was around USD$5k. That's private, by the way - public would have been free (ie covered by the system paid for by the 2% medicare levy in the case of Australia).

I don't disagree the costs of heathcare are super inflated. My contention (and this is purely anecdotal, I don't have hard facts) is that healthcare workers in the US get compensated extremely well. I would like a comparison of doctor/surgeon compensation in different countries... I believe US healthcare professionals get compensated very well in comparison to those in other countries.

These numbers [1] are old but are probably still in the ballpark. US healthcare workers are compensated well, but not all that much more than comparable developed countries. And quality of healthcare in the US is top ten at best [2].

No, the prices are only explainable by profound inefficiency and corporate rent-seeking. The US is paying hugely inflated prices for (at best) similar outcomes to its peers - now that's market failure!

Needless to say I expect the US will adopt a single payer healthcare system within the next 10-20 years, like every single one of its peers, simply because the current system is unsustainable.

[1] https://journal.practicelink.com/vital-stats/physician-compe...

[2] https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...

Even only taking salaries into account, you've got the surgeons and all associated staff in the removal of the tumour. The guys in the lab to cultivate the white blood cells, everyone who needs to fill out paperwork, more surgery, monitoring and check ups. Then add into that all the costs of running a hospital, proprietary medication, regulatory compliance, cost of all the single disposables. The costs very quickly add up to a few hundred thousand before anyone's even taken a profit.

I presume the incremental cost of treating each additional patient will be considerably smaller once the overheads of treating the first person are made.

Not necessarily. Even in regular use, this treatment will still involve killing off the patient's immune system, which will require days in hospital isolation. In addition, the culturing and screening of the immune cells to create a population that is primed to fight cancer is a labor-intensive process that has to be done for every patient.

Reply on news.ycombinator.com