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Day 1 of new Hep C Treatment
When I was first diagnosed with Hep C the nasty bitch nurse told me a single drink would kill me (bullshit) and that there was no cure (true).
I've had Hep C now for many years (more than 15). About 9 years ago I went to the liver clinic to begin peginterferon but every appointment was deja-vu. The doc would talk to me and maybe order some tests, they'd give me a DVD about how to inject myself, but they'd never give me an actual prescription. After about 4 of these instances I just stopped showing up.
A few years ago, my partner was lucky enough to be selected to participate in a trial of these new 'miracle drugs' we've all heard so much about. He was inconsistent with forgetting doses and so on, and they threatened to kick him off the trial more than once. Despite his erratic dosing, the treatment worked. Now we had a backpack full of spare 'miracle drugs' that had not been approved for use yet. Even if they were approved, the chances our Govt would subsidise it weren't great, according to the liver clinic. They were so excited about these drugs and still are, as you will see.
My plan was to use the leftover research drugs to cure myself. The drugs you get are different dependent on the strain of HepC you have and how much damage your liver has sustained. We had the same strain but I didn't know what shape my liver was in. The drugs sat in the bag and I kept meaning to start but I am a slack fuck and after a few months I became concerned that they might have expired or something and basically talked myself out of it. I threw the bag away a few months ago and now I realise that was kind of like throwing away a bag of cash but ah well, you live and learn.
Our Government hemmed and hawed but eventually the new treatments were approved and subsidised. You don't need to be dying or cirrhotic to qualify - you just need to test positive for Hep C. So, with new hope I went off to my doc for a referral. He said the new treatment was super popular and I'd be waiting awhile. That was true. I waited about 8 months before the liver clinic called me back. They did blood tests, ultrasound and fibroscan to check the genotype and see what condition my liver was in. Then they booked the follow up, which brings us to yesterday.
I was expecting more tests and more delays before getting near these drugs. Doc tells me my genotype, that my numbers are good and that my liver has no significant damage or scarring. That shocked me a bit after all these years of abusing it. It also amused me that something in my guts looks like a smiley face potato gem on ultrasound. The lady doing the tests was so visibly excited about giving this treatment. She kept saying that it would change Hepatology forever, bring down the need for transplants etc. It was really cool to see the genuine joy this discovery had brought to the staff at the liver clinic. I told the doc I had expected bad news about the state of my liver.
"I can give you some bad news if you want?"
"If you don't need to, I can live without that".
"Ok, well now I just need to call the Government."
All the paperwork and housekeeping done, Doc held out his hand and said, "Right, that'll be $70,000." I giggled and he giggled with only slightly less enthusiasm. I think he's used that line a few times before. Off to the hospital pharmacy.
Pharmacist takes my scripts and does pharmacist things while asking pharmacist questions for about 10min. He tells me it'll take about 20mins to process so I go for a walk. While walking, I realised that I only had $7. That's enough for one subsidised prescription but I was on two drugs. Shit. Here I am about to pick up tens of thousands of dollars worth of life-saving help and I can't even find seven lousy fucking dollars. Typical shitty me.
So, when my number was called and the next pharmacist starts her counselling spiel about how to take the medicine, I interrupt her with, "Um, before we get too excited," and explain my stupid seven dollar dilemma, asking if I can come pick the medication up the next day. "Oh no," says lady pharmacist. "We don't money getting in the way of anyone receiving this treatment. You are starting today and you have a month to pay. Just pay it when you pick up next month's supply." I think I can find $13.80 in a month.
So now I am sitting here with a box of Sovaldi, a box of Daklinza and a real hope of being free of Hep C within 3 months. Including medications, tests, consults and everything else, all I need to contribute to this treatment is a $50 note, and I'll get a little change.
I can understand why every not every country is in a position to cover this treatment. However, when I went to the internet to read about other people's experiences, I found people from first world countries jumping for joy that it 'only' cost them $7000. I could not access it at that cost. It baffles me that they aren't treating this like a vaccine, given the potential it has to dramatically lower infection rates worldwide - even including those people who get treated and contract it again. I realise people reading this may not be able to afford it. I really hope that changes and changes soon. Any Aussies reading this who may not know about this treatment or might be lazy - get your referral. Just do it.
Just took my first doses. Wish me luck!
As medical costs mount, Japan to weigh cost-effectiveness in setting drug prices
By Takashi Umekawa
TOKYO (Reuters) – Japanese doctor Yasushi Goto remembers prescribing the cancer drug Opdivo to an octogenarian and wondering whether taxpayers might object to helping fund treatment, which at the time cost hundreds of thousands of dollars, for patients in their twilight years.
Japanese have easy access to new medicines, whose prices are decided by the government and subsidized by the country’s public health insurance system.
But that may change. Japan, confronted with the ballooning cost of caring for an aging population, is introducing a cost-effectiveness test for drugs as a means of capping prices.
There are no plans to deny care for patients of any age. But limiting the prices of innovative but costly treatments might chase new drugs out of the $86 billion Japanese market, drugmakers say.
“If you ask whether it’s worth prescribing an 85-year-old patient Opdivo, a lot of people will say no. But patients and family members are going to say yes,” said Goto, who works at the National Cancer Centre Hospital.
Patients also fear more drastic changes, such as denying access to new medicines; Prime Minister Shinzo Abe’s economic council in December proposed considering cost in determining whether to approve treatments.
“For cancer patients like us, it’s not acceptable if the government applies a cost-effective analysis in determining whether to approve treatments,” said Yoshiyuki Majima, a director of patient advocacy group Rare Cancers Japan.
SUSTAINABILITY OR ACCESS
The Japanese government estimates that public medical spending could surge 75 percent to 68.5 trillion yen ($624 billion) by 2040.
“It is obvious that Japan will face difficulties in providing social security service,” said a government official involved in the discussions, declining to be named because he is not authorized to speak to media. “The cost-effectiveness analysis is a means to secure sustainability.”
The system that will be adopted in April, according to a draft published on the health ministry’s website, compares the cost to the effectiveness of new treatments using an “incremental cost-effectiveness ratio,” or ICER.
ICER, already used in countries such as Britain, considers how much it costs to give a patient one additional year of healthy life compared with existing alternatives. If that exceeds 5 million yen, for example, the government may insist on a lower price, according the policy draft.
There has been little public discussion; weekly meetings so far have involved mostly Health Ministry officials, doctors, academics and drugmaker executives.
“If I have rheumatoid arthritis and I can’t write or type, but then I get a treatment that enables me to go back to work, pay taxes, and take care of my family, that benefit is not going to be captured by the ICER,” said Kevin Haninger, a vice president of Pharmaceutical Research and Manufacturers of America, a lobbying group.
In an interview with Reuters, he insisted Japan should carefully consider an impact on the industry when introducing such analysis to reduce drug prices.
“If Japan is going to cut prices so much, I think Japan will really run a risk of losing its current position,” he said.
LUCRATIVE MARKET NO MORE?
Drugmakers have been complaining about price cuts since 2017, when the government decided to review costs more frequently.
Japan has slashed the price of Opdivo, developed by Ono Pharmaceutical Co Ltd and Bristol-Myers Squibb, by more than 75 percent in the last two years. It has also lowered Gilead Science’s hepatitis C drug Sovaldi by 32 percent since 2016.
But while drugmakers threaten to pull back from Japan, the government is prepared to call the industry’s bluff, saying Japan is too lucrative a market for companies to ignore, according to two government officials, who declined to be named because they are not authorized to speak to the media.
Unlike the United States, where insurers may deny claims, or the UK, where patients can be denied costly drugs, Japan is seen as a relatively predictable market because of its social insurance system.
For example, Novartis’ Kymriah, a type of therapy in which a patient’s T-cells are modified to attack cancer cells, is expected to be approved in Japan this year.
The price for pediatric leukemia patients, to be set by a government panel after approval, is expected to start at about $475,000, similar to U.S. prices. With an estimated 250 Japanese eligible for treatment with Kymriah, sales in Japan are a potentially lucrative addition to Novartis’ bottom line.
Novartis declined to comment on potential effects of a new pricing policy.
Goto said the government should focus on reducing prescriptions for illnesses that are not serious, rather than costly but possibly life-saving treatments for a small number of patients.
“Flu medicines, for example, can be seen to have very low cost-effectiveness because they don’t save people’s lives, except those of infants or pregnant women, compared with cancer drugs that are critical for some patients,” he said.
(Reporting by Takashi Umekawa; Editing by Ritsuko Ando and Gerry Doyle)
from MAGA First News https://magafirstnews.com/oan-newsroom/as-medical-costs-mount-japan-to-weigh-cost-effectiveness-in-setting-drug-prices/