Expensive drugs

TWO NEW, powerful and expensive drugs to treat very high cholesterol are raising concerns about the ability of public and private insurers to pay and whether the benefits the drugs bring will outweigh their long-term costs. The drugs – Praluent, made by Sanofi Regeneron, and Repatha, made by Amgen – have shown phenomenal results in driving down the levels of so-called bad cholesterol, or low-density lipoprotein (LDL) cholesterol, in patients at high risk of cardiovascular disease who don’t respond to or can’t tolerate statins.

Many doctors say LDL levels should be below 70 milligrams per decilitre of blood in the highest risk patients and below 100 in other at-risk patients.

In one trial, Praluent drove LDL cholesterol below 25 milligrams a decilitre.

Some researchers report even lower levels. The trouble is that nobody knows yet whether the drugs will prevent heart attacks, heart failure and strokes, and whether there are risks from pushing LDL levels too low. Larger, longer clinical trials are under way to get the answers, probably by 2017.

At first glance, the new cholesterol drugs appear less expensive than the costly new drugs to treat hepatitis C, whose exorbitant prices have raised alarms among health experts, insurers and patients.

The list prices for two of the new hepatitis C drugs reached R1.1 million to R1.3 million for a 12-week course of treatment and were high even after manufacturers’ discounts. But the drugs, which cured a vast majority of patients in clinical trials, are essentially a one-time cost.

The cholesterol drugs, by contrast, will be taken for a lifetime. The list price is R200 000 a year for Praluent and R195 000 for Rep-atha. At these rates, the lifetime costs could be staggering.

What can be done to restrain prices? More competition should help. Doctors should keep patients who don’t need the new drugs on statins, which cost pennies a day and are generally safe and effective.