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I was reading the news this morning and came across this item:
Is it that one is before the infection and the other is after? I know someone who has had the injection often and I doubt she paid that kind of money.
The dog that bit you. was it shown/known to be rabid?
As PHCheese noted: one is prophylactic and the other is treatment.
My bet would be placed on regulatory cost and economies of scale. American and Canadian manufacturers have to jump through more hoops to get their product approved. This cost must be distributed through the number of vaccines sold. Since there is a lot less need for a human vaccine in Canada and the US than there is in India, the result is a lager fixed cost gets distributed among much, much fewer items.
So why does the vaccine distributed to wild animals cost so much less? I’d bet the regulatory cost of producing it is much lower – minimal to nonexistent. Plus storage and record keeping requirements are likely a lot less onerous than for human (or even veterenary) vaccines. Who cares if a few wild animals die from a bad reaction to that vaccine? Uncle Bob or Fluffy the cat? That’s different!
Seawriter
The WHO recommendation for post-exposure treatment is wound care, one dose of immunoglobulin, and vaccine therapy:
Rabies is endemic in India, although I had no reason at all to think the dog was rabid; he just didn’t like me. Still, only an idiot would take any chance.
Are you talking about the vaccine or the medication after you’re bit? Aren’t they different concoctions?
By the way, raccoons are highly rabid. Stay away from them. I saw one coming out of my neighbor’s back yard early one morning last week. Right here on Staten Island, which is part of NYC.
It would be my bet, too, although I’d like to hear from someone who really knows before jumping to conclusions.
If my bet is right, though, it would be an interesting example of the way American health care costs get driven up to ridiculous heights by these regulations. They may make sense, in that it’s possible we can’t fully assess quality control at Novartis in India and therefore can’t be absolutely sure the vaccine is as safe as the same vaccine manufactured in the US. Or we might have some rent-seeking going on: Perhaps their competitors hire lobbyists to terrify regulators with stories of Scary Third World drugs made in Dirty Third World places. I don’t know, but the latter wouldn’t surprise me a bit.
There are lots of different vaccines that are hugely safe, massively trialed all over the world, and effective. I don’t know whether the vaccines they use for animals are substantially different from the ones used for humans. The vaccines can be used to prevent rabies both before and after exposure to the virus — but you have to be treated fast, because the disease is 100 percent fatal if symptoms develop. (I think there’s one known case of someone surviving, but it’s about as unsurvivable as it gets — and also 100 percent preventable with vaccination.)
I think, though I’m not at all sure, that there are two kinds of immunoglobulin, human and equine. I’m not sure whether they’re equally effective. But the recommended treatment if you’ve got reason to think you’ve been exposed is both; failing that, the vaccine by itself is hugely effective if you get it on time and administer it properly. It’s easy enough to administer that there’s no reason people couldn’t do it at home. (I did.)
I was talking with a gal who worked in the finance department of a pharmaceutical company, a number of years ago. She told me that the high cost of drugs in the U.S. is due, in part, to the fact that we are subsidizing its use in poorer countries. No doubt there are a plenty of reasons why the rabies drug is more expensive here than in India. That is just one of them.
But is it ridiculous heights? It depends on how common the use of Anti Rabies Immune Globulin is in both countries. Suppose, (because rabies is endemic) in India 1000 sets of the vaccine are needed for every one set in Canada. The Indian cost is USD 9.36, while the Canadian cost is USD 1063,87. Divide the Canadian cost by 1000 and you get a cost of USD 10.64. That is still higher than the Indian cost, but not outrageously so.
This is a major reason why “orphan drugs” used to treat rare diseases are so expensive. The development costs get divided over fewer doses.
Seawriter
I can find no evidence that the US government subsidizes rabies vaccination in India, can you? Where would you look for that in the budget?
Lots of Americans make private donations, for sure. But the Indian pharma sector is really competitive and innovative — enough to be developing much cheaper vaccines and franchising the business.
The rabies vaccine costs $1000 in Canada and $2000 – 7000 in the US because that is what the market will bear. The market in India will not bear even $100 dollars for vaccine because India is poor and rabies prevention in pets is rare so the incidence of human needing the vaccine is high.
It is a rare life saving treatment, people in the US and Canada are willing to pay a lot for it. Regulation may double the price, but the market value is most of the story.
Why should it cost any more than the cost of shipping it from India? Why aren’t we importing it from India and taking advantage of their comparative advantage? That’s how free trade benefits everyone. This isn’t an orphan disease, it’s rabies. India has a comparative advantage in manufacturing rabies drugs because rabies is endemic in India. Not enviable, but still a comparative advantage: They can make a profit by manufacturing in scale. We can’t. That’s exactly why we believe in free trade, isn’t it?
Would they be, if they knew they were literally paying a thousand times the price of an equally effective treatment — and paying it out of their own pockets? I sure wouldn’t be.
Really? You’d voluntarily get rabies instead of shelling out for the cure, simply because other people get the cure for less money?
No, of course not. But if I had the choice between one equally good treatment and the other, and one cost 7,000 dollars and the other cost 70, I’d take the one that cost 70 and save the rest of the money for a rainy day. Wouldn’t you? Of course no one would voluntarily get rabies. But I’m so confident in the treatment I received in India that I literally bet my life on it. It didn’t cost 7,000 dollars.
a) Yabbut, you don’t have that choice. Importing drugs from India that haven’t been approved by the FDA/Health Canada isn’t legal.
b) In North America, the vast majority of patients will never see the cost of the treatment, because it’s paid for by their employer’s health plan. The insurance company is the customer, not the patient, and the insurance company is, apparently, willing to pay the higher price.
c) Being “confident enough in a treatment to bet your life” isn’t saying much when the odds of death from forgoing treatment are 100%. People are willing to pay vast sums for even a tiny chance of avoiding death.
Because those in the US and Canada demand the vaccine from India go through the same testing as vaccine produced locally. Those overhead costs get divided among the US and Canadian users.
Is the testing required overrigorous and excessive? Perhaps. But remember what I said earlier about Uncle Bob and Fluffy the cat? It applies equally whether the vaccine was made in India or the USA. No government bureaucrat ever got failed to get promoted for demanding one more test. Someone complaining because a vaccine approved by bureaucrat hurt Uncle Bob or Fluffy could, potentially cause that bureaucrat to lose a promotion or step.
Organisms, whether individual creatures or organizations respond to stimuli. Unless and until the reward/punishment menu is changed for government employees, this will continue. Because, ultimately we citizens demand it.
Seawriter
d) Cases of rabies in humans is incredibly rare in Canada, much more so than in India. A drug company trying to turn a profit on so few customers would have to charge a really big markup.
e) With over a billion people, the benefit of saving a life in India may be seen to be less than in North America, therefore lower drug cost. The principle of inflation works for human lives as well as with currency.
This is perverse, there oughta be a law. Or perhaps a free market solution. Could doctors in the US fedex batches of vaccine from India (or some other low cost supplier) and then pocket the difference? That sounds like a good deal for the doctor. I checked Fedex from India to Houston and lo and behold they will not ship vaccines. I guess you could lie, but this is starting to sound like a conspiracy.
But really, the issue here is insurance as a concept. At some point, and we have reached that point, the insurance companies, care providers, and the gov’ment are all content to milk the rate payers as long as things go smoothly. It is called regulatory capture and it is delightful if you are them.
Isn’t there also some circumstances with single payer systems where countries set a maximum amount they are willing to pay for a particular drug?
Precisely. In many cases drug prices are set by the government or at the very least there is a “most favored nation” provision which says you must sell to my country at a price which is no lower than any other country you sell to (for crying out loud why does Canada get a break) .
There was quite the squabble over this during the GW Bush administration. I believe the argument against MFN was if the US rate insurance rate payers were not milked then it would slow the development of new life saving drugs so it was worth it (or something like that). That argument prevailed and we did nothing.
My favorite author on the subject of healthcare costs in the United States is Dr. Regina Herzlinger: Who Killed Health Care? At one time she was with the Manhattan Institute as an author, and she may still be.
Her book was published in 2007 when we were on the brink of an expensive national healthcare program. The book was her attempt to alert the consumers of healthcare (us) about the proposals being considered in Washington–and she knew what was being considered because she was one of the advisers.
Her gravest concern was the ridiculously high cost of healthcare. She felt that the measures being looked at (and that had already been adopted in some states ahead of the national program–which was why we already knew the results) were driving costs up by squelching competition and innovation and reform. Those 3,000 unread pages of the Affordable Care Act (ACA) contained a lot of competition-dampening measures because the people writing the bill were in the big healthcare industries: hospitals, insurance, and pharmaceuticals. Some of it was an attempt to control market share.
The two groups missing: doctors and patients. Because healthcare is so immersed in government policy (Medicaid, Medicare, and Veterans Administration, plus the regulation of the insurance companies by the government), the good news is that it moves slowly. The book is still current, and her predictions came to pass in the ACA.
I think what Spin means is that if a company develops Medicine A it then expects/needs a profit of $X. But it would be bad form to withhold meds from poor people in poor countries. So they basically give it away there and make up the difference here.
Interesting. If it’s the same concoction for what they immunize animals as what they give to cure, then I can’t answer for the price difference. I think I get charged around a $100 for my dog’s annual shot. From what I read, a human with rabies gets five shots over the course of a few days. Were you counting each shot for the $1000 or was the total of all the shots $1000? If the latter, that brings it closer, and given that humans probably get better quality products it could be that $1000 is not outrageous.
Here’s the problem with anything healthcare related: Most politicians are either ignorant or willingly deceitful in conflating “price” and “cost” and the average journalist is no better, which also makes for an ignorant consumer.
Governments around the world are sole purchasers of pharmaceuticals. They negotiate prices. Bernie Sanders and Hillary Clinton both want to do the same in the US. But the price of a product is not the same as the cost of a product. Ironically this government interference prevents companies from socializing the cost of the product worldwide. Therefore, North American consumers bear a disproportionate share of the costs.
Should Sanders and Clinton be as successful in this authoritarian game as the rest of the world thousands of drugs will simply disappear completely.
Never ask “What is the cost?” unless you want a detailed analysis of manufacturing, distribution and marketing. If all you want to know is what you’re paying then you may ask about price.
Agree on all points.
1) I think people should have the choice. I believe the FDA is too easily subject to regulatory capture, and having this kind of choice would bring down health care costs substantially.
2) Exactly, making it particularly difficult, if not impossible, for markets to work.
3) I certainly think people should be free to spend vast sums of money on quackery if they prefer. If someone wants to spend 7,000 bucks on what he believes to be an extra-special life-extending grapefruit, that’s his business. But I don’t want to waste my money that way, and don’t want to subsidize his irrationality.
I don’t think there’s any rational reason to believe rabies vaccines in India are of a lower quality. If I’d felt so for even a minute, I would have taken the first flight back to the US. I have a credit card and a US passport. (Mind you, I was also missing my nose — that too was a pressing concern. But it was only my secondary concern after “rabies.” No sane person messes with rabies. As it turns out, Delhi’s also a much less expensive place to have your nose sewn back on.)
Is anyone else missing ole Docjay? By now we’d know exactly why and probably be rolling on the floor, to boot.
Prescription pharmaceuticals are not covered by Canada’s “single-payer” health system. The gov’t insurance pays for trips to your GP and “medically-necessary” treatment in hospital. It doesn’t cover drugs.
That is interesting.
Geesh, the things the Democrats never tell us.
Wow.
Most provinces do have supplementary drug benefits for the poor, but they aren’t part of the “universal” health system.