The outright exorbitant cost of good health care

What Would You Spend
to Save Your Child?


I'm guessing that most of us with children have listened to a cough or looked at a cut and thought, "Is it worth going to the doctor for this?"

In addition to the outright cost, a doctor's visit often proves to be quite a hassle. Scheduled appointments for vaccinations or routine checkups are one thing. But an emergency visit? What a pain!

Those types of deliberations are really a luxury. Eventually, the nagging in our brain gets us off the couch or out of what we're doing, and we drag our afflicted kid to the walk-in clinic or emergency room for some professional care. At the end, we get a bill that we hope is the entire thing (meaning, no "surprises" from an out-of-network-whatever that happened to be in room that day), grimace when we pay, and go home.

It's just another story to tell at work or the ball field the next day.

But things are different when your kid isn't just a little sick, or needs more than a few stitches. Arguably, parents in that situation aren't facing "choices" at all. They are looking at the difference between life and death, and what stands in between can be more than a million dollars.

The FDA just approved Novartis's new spinal muscular atrophy (SMA) drug, Zolgensma. The company claims the drug can defeat type 1 SMA with one treatment, which is a godsend. SMA is divided into "types" based on the age at which it afflicts the patient. The lower the number, the younger the age. And the younger the age, the more severe the effects. Type 1 SMA is often fatal.

The current treatment for Type 1 SMA, Biogen's Spinraza, hasn't been around long and cost $750,000 for the first year, and then $375,000 for each subsequent year, with a 10-year treatment window. The drug costs $4,125,000 over the span of treatment, and the Institute for Clinical and Economic Review (ICER) estimates that Spinraza costs $728,000 per quality of life adjusted year (QLAY).

Given the cost of Spinraza, leading up to the approval of Zolgensma, Novartis argued that its new compound would be "cost effective" at $4 million to $5 million. As the day of approval drew near, Novartis's CEO said that even though it would be worth it at that price, the drug would cost a fraction of that.

Now we know the fraction, about 50%.

Just after receiving approval the Friday before Memorial Day weekend, Novartis announced that Zolgensma would cost $2.125 million. Which should put it somewhere around $250,000 per QLAY, a bargain compared to the current standard of care, but way above the industry threshold of $150,000.

The drug has the distinction of being the most expensive medicine in the world. But don't worry, you don't have to pay for it all at once. You can go on the installment plan and pay just $425,000 per year for five years. And there's even talk of a money-back guarantee if the drug doesn't work for your patient.

Nice…

But it doesn't really matter. The only thing that's certain is that parents of children with SMA will do anything – pay anything – to help their children live.

And that's the problem.

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