welcome to the organic green doctor blog

i am a family physician who was diagnosed with
early mild cognitive impairment(mci) amnestic type on december 21, 2010
this is a precursor to alzheimers disease
because of this diagnosis i have opted to stop practicing medicine
this blog will be about my journey with this disease
please feel free to follow me along this path
i will continue blogging on organic gardening, green living,
solar power, rainwater collection, and healthy living
i will blog on these plus other things noted to be interesting

Wednesday, March 9, 2022

my story revisited #127-the price is still an issue


one of the issues with my drug aduhelm or aducanumab is that it will cost now around $28,000 a year to get monthly infusions 

in 2014 when i wrote the blog below the drug solanezumab showed promising as a treatment to slow down alzheimers disease
its a monoclonal antibody that binds to the amyloid protein to remove amyloid from the brain
it use in early alzheimers disease was not proven to be effective in clinical trials

they are now using it in a long term trial called the a4 study where its given to folks with no symptoms but who have positive biomarkers for alzheimers ie positive spinal fluid analysis and or positive amyloid pet scan
the idea is that removing the amyloid months to years before symptoms start might slow down the disease

my drug aduhelm and other similar drugs are doing the same thing now in clinical trials on these prealzheimers patients
the thinking is that we need to be treating folks years before symptoms start

now we have blood tests that can identify folks that are prealzheimers 
mostly only available in clinical trials

it can cost over $30,000 a year for medications for rheumatoid arthritis to treat a patients disease
medicare and other insurances cover some or all of the cost

its interesting thats slightly more than the cost of aduhelm or aducanumab infusions for a year

the potential cost of solanezumab was an issue when i wrote this 8 years ago
the cost of aduhelm or aducanumab is an issue

the cost of rheumatoid arthritis infusions or injections can be $1,300-$3,000 a month
that is about the cost of an aduhelm or aducanumab infusion a month

where is the outcry over medicare paying for these arthritis drugs

now i know that the effectiveness of these rheumatoid treatments are quite good
aduhelm is not quite proven

the average cost of chemotherapy drugs can cost $1,000-$12,000 a month

so the price for aduhelm seems to me to be about right when compared to these other drugs

in the next 2 years several alzheimers disease studies will be started with
different criteria for who gets in them
most of not all will be given a new biological infusion called
this will be given monthly for 3 years
it works by binding with antibodies to beta amyloid the sticky stuff
that accumulates in the brain
that  is thought to be the cause of alzheimers disease

the beta amyloid  is then removed from the brain
if it works it will slow down the disease
if we are all lucky cure the disease

there are several diseases now that use the same approach for
treating them
one eg is rheumatoid arthritis
patients may get an infusion of biologicals every 1-2 months
with names like infliximab or adalimubab
thats Remicade and humira

cost of getting infusions for a year are $10,000-$30,000+

note the similar sound to their generic names to the new drug
for alzheimers disease that will be used in these studies

the drugs for alzheimers disease used now
remember they only treat the symptoms
not the disease

these prices below are for 30 days treatment
cash prices from costco pharmacy

donepezil generic aricept $11.41
aricept brand                  $417.67
aricept 23                       $388.90 this was designed after the aricept
went generic and the price plummeted for the generic
folks dont let doctors put your family on aricept 23
its the things big pharma does when their drugs go generic
it doesnt work any better
and it cost you hundreds more a year

rivistagmine generic exelon $52.64
exelon brand                       $226
exelon patch                       $352.25
its no better than donepezil
its used instead of donepezil when donepezil causes stomach issues

for me
my stomach issues improved after 30 days and i was able to tolerate
the donepezil

namenda for now its brand is only $328.08
later this year a new product will be introduced called
you got it namenda xr
sounds familiar
the patent on namenda is going out next year
then other companies can make it

it will not work any better than namenda or the new generic
you know the cost will probably be in the $300-$400 a  month price range

namenda is usually added to the donepezil when the donepezil
loses its effectiveness later on in the disease
some are taking it with donepezil as soon as the diagnosis of
alzheimers is made
i have opted not to do this combo yet
when it is needed i probably will not be capable of making that

if you presume all patients with alzheimers disease in the united states
are on donepezil
5,000,000 people have this disease now
thats $57,000,000 a year for the generic drug
add namenda to them
thats $1,640,000,000 a year more

we know this new solanezumab that will be used in these new
alzheimers disease trials will be expensive
if it works all those newly early diagnosed patients will be getting it
those of you who are young and who are tested for alzheimers disease
will probably start this drug early in life
maybe in the 40s
and will take it for the rest of your life
if you want to slow the disease down

cost im presuming for a years treatment will be $20,000-$30,000+
a year
we are talking about 20 years of people who will be told you will get
alzheimers disease
there will be millions of people wanting this drug

if you multiple the cost times 5,000,000 people an underestimate
thats $150,000,000,000 a year for this new drug

but can we afford as a society to spend that amount of money
each year to prevent or treat this disease

that 150 billion dollars just so happens to me the amount
that medicare and medicaid spends now each year on
alzheimers disease patients

interesting huh
that does not include what private health insurance pays what long term
care insurance pays and what we all pay out of our pocket

its a financially devastating as well as socially devastating disease
can we afford these new treatments

maybe we can

lets just hope that in the next 3-5 years that this new drug
works to slow down or stop this disease
so that we can answer this question
it looks like now 8 years later we are facing this dilemma with aduhelm or aducanumab
what are we going to do

the organicgreen doctor

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