Tuesday, November 1, 2011

The Future Cost of Type-1 Cures

Every now and then, someone will ask me how much I think a cure will cost, or they will complain that a cure that I take seriously will be too expensive (whatever that means), even if successful.  I have three thoughts that I always try to keep in my head when people talk about the cost of a cure:

First, it is a total waste of time, to discuss the cost of something that you can not buy.  No one really knows how much something will cost, if they can not sell it, and you can not buy it.  It's like discussing ghosts or fantasy football.

Second, "demand creates it's own supply" which is an economics phrase, that basically means that if people want something badly enough, then other people will find a way to make those things cheaper, which will change the basic economics of availability.  An example has to do with transplanting beta cells recovered from cadavers.  Right now, that doesn't result in a cure.  Some people say that could never result in a general cure, because there are not enough donated cadaver pancreases.  So such a cure is impossible, because even if it worked scientifically, there would not be enough cadaver pancreases.  But I don't agree with that logic.   For one thing, if cadaver pancreases could be used to cure type-1 diabetes, there would be a huge increase donated pancreases.  Groups like ADA and JDRF would launch public relations campaigns.  There would be scores of "feel good" local news articles about people cured with donated pancreases.   Suddenly, there would be many more pancreases donated.  At a minimum, every grandparent of a type-1 diabetic would be signing those forms. Furthermore, I would expect the technology to improve over time.  So if the first cure takes beta cells from three pancreases to cure one person, over time, it might take 2.5 and then 2, and maybe eventually 1.5 or even just 1.  That means that even thought the number of pancreases doesn't change, how many people they cure would change.  These are two examples of how "demand can create it's own supply".

Third, technology makes everything (high tech) cheaper.  Computers that cost over $100,000 dollars in 1970, cost $2000 in 1980, and so on. My daughter has a $400 iPad, which probably has a lot more computing power than an entire Apollo moon launch from the 1960s, and so on.  Many of the possible type-1 cures that people are afraid will be "too expensive" are very high tech, and we can expect them to get cheaper over time as we learn how to build them, and the general level of technology improves.

So my policy when thinking about cures myself, is not to worry about cost.  I know others do, and so I include that information when I have it.  But for myself: I only worry about availability, not cost.  Right now we have nothing.  So having a cure, even a really expensive cure, would be such a huge step forward, that I just can't bring myself to worry about the price.  I am sure that even if a cure starts out "too expensive" it will not stay that way for long. 

Joshua Levy
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF or JDCA news, views, policies or opinions. My blog contains a more complete non-conflict of interest statement.
Blog: http://cureresearch4type1diabetes.blogspot.com
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Scott S said...

I estimate the cost of a type 1 diabetes cure, should one emerge in the not-too-distant future, would actually be around $100,000, although that cost could come down slightly, it may not come down as dramatically as we'd like to see. Catch my blog post on that subject at http://blog.sstrumello.com/2010/11/100000-diabetes-cure.html .

David said...

Interesting post, Joshua, as usual.

Can't say I fully agree with you though. IMHO is logical to discuss cost of something you can't buy. What is projected cost of the new electric car they are developing at Hyundai? What will iPhone 5 cost? This happens all the time.
From my perspective from inside the drug industry, I'm not involved in pricing so much, but get to hear some discussions. Drugs are generally priced in comparison to other similar drugs. But when a disease is life threatening, I've found certain thresholds to hold. If it's a treatment (not a cure) designed to prolong life, such as for a serious cancer, it's tough to push the past the $100,000 a year barrier. But a patient may live long enough for multiple years of treatment.
For a cure, there is less historical data, as very little has been cured. But I think it's safe to say >100,000 dollars. So I agree with Scott.
... david

Papa Carlitos said...

Fully agree with Josh, cost is irrelevant, just get it done, then we'll discuss the price.