I found this from the Guardian by way of Gorette at Daily Kos about an anti cancer drug called Avastin which is being used by ophthalmologists to treat wet macular degeneration. The problem is, Genentech, the manufacturers want to market a variant of this drug, which costs about £10, in smaller individual vials which will cost £1000! That's a hundredfold difference for, essentially, the same drug!
Now I know there can be a price difference in the same drug depending on whether it comes as a tablet or an infusion - Ciprofloxacin is a case in point. A packet of Ciprofloxacin 250mg tablets costs a few quid. One bottle of Ciprofloxacin in 250ml of saline costs about £25. Here there's about a fivefold markup, which is why pharmacists insist that oral treatment be used in preference to intravenous treatment.
But a hundredfold difference? Is this justified? It would cost the NHS £40 million to give Britain's 20 thousand ARMD sufferers two injections each. The battle over Herceptin pales into insignificance.
The National Institute for Clinical Excellence (NICE) cannot licence Avastin for treatment of wet macular degeneration (at £10 per vial), because Genentech won't apply for a licence. Instead they want their specially formulated (£1000 per vial) Lucentis to be licenced for eye treatment.
Now don't get me wrong, Drug companies spend a lot of money developing these medicines, and they deserve a fair return on their investment. The question is, is a hundredfold mark-up fair?
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I don't know where they get their prices from, but the BNF (British National Formulary) price for Avastin is £242.66 for a 100mg vial & £924.40 for a 400mg vial. Theoretically you could treat many patients from the 1 vial but it is not good practice, from an infection point of view, to use 1 vial for several patients unless it has been designed as a multidose vial ie contains a preservative.
I am in no way condoning the huge mark-up that drug companies make, but in general the smaller & more fiddly something is to make, the more expensive it is. Eg take plain simple sodium chloride infusions - the price is virtually the same for a 50ml, 100ml, 250ml, 500ml,or 1L bag, but volume for volume you get more for your money the larger the bag.
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