Well, there are more reasons than can be covered in a single post, so I'll start with just one: economics. More specifically, return on investment. And the economics here, as in so much of medicine and health care, are driven by fear rather than by a rational cost-benefit analysis.
Antibiotics have been so good for so long, that few people fear losing a life they cherish to a bacterial infection. Antibiotics are one of the few medicines that reliably cure people rather than just alleviate symptoms or slow disease progression. And they do it with so few side effects that doctors feel comfortable prescribing them just in case they might actually be helpful, or to make a patient feel like they are being treated. In other words they are used as both prophylactics and placebos, as well as effective treatments for specific diseases. I can't think of any other class of medication that answers to this description.
And they are cheap. A daily dose of vancomycin costs about $10, and it will reduce the mortality rate of systemic MRSA infections from about 80% to 30%. Think about that - for a couple hundred dollars, patients go from near-certain death to a decent chance of a full recovery. Daptomycin, at around $120/day, is considered a very expensive antibiotic, prescribed reluctantly for MRSA by some physicians, even though it will give better outcomes for some infections.
For perspective, compare these costs to those of the newer targeted cancer chemotherapies: $50K (and higher) for treatments that make patients miserable and extend life by weeks or months at best.
Any rational analysis of life-days saved by the most expensive antibiotics would conclude that they are more valuable than targeted cancer chemotherapies by at least a factor of ten. A rational market would price them accordingly, attracting more investment into new antibiotic R&D.
But that's not likely to happen, and the chief reason is fear. Because antibiotics have been such good drugs (and cancer drugs have been such bad ones) we don't fear death from bacterial infections nearly as much as we fear cancer. The result is that cancer has been romanticized. Think about how many book, movie and mini-series plots are driven by a battle with cancer; how cancer patients are encouraged to view their illness and treatment as a hero's journey; and how we as a society have declared war (the most romantic pursuit of all) on cancer.
There's no mystery here about the economics of antibiotic development - they stink. Drug companies are much better off putting their resources into drugs they can charge stratospheric prices for (ie cancer treatments) or ones they can keep patients on for life (like statins). Drugs that are cheap and actually cure people in a couple of weeks are just not going to be on their radar.
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You don't explain why antibiotics are cheap, only that they are, which is why drug companies are unlikely to develop them. Don't the drug companies get to set the price for medicines that they develop, at least initially while they are the exclusive manufacturer?
ReplyDeleteOr is there some special law concerning antibiotics where the price is set by some government agency, or what?
Antibiotic prices are what the market will bear. The problem in pricing new antibiotics is that the old, cheap (meaning generic) antibiotics still work pretty well. Most cases of strep throat still respond to amoxicillin. Most UTIs still respond to ciprofloxacin. So in the absence of any susceptibility test data, doctors will prescribe them first. It's only when the patient comes back that they will consider switching to something newer and possibly more expensive, even if it is more effective.
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