Amphotericin B

Doyle_G

Out of curiosity, can anyone tell me why the anti-fungal drug Amphotericin B is such an expensive drug?? I was told by a lecturer that a treatment with it can cost £30,000 sterling!!!!! is this true??

Vorsprung

That's weird, I was looking up the cost of Caspofungin, another anti-fungal today. 1st dose was something like £411 (70mg), subsequent doses (50mg) were about £300. Maybe it's something to do with production?

SomeDose

Generic conventional amphotericin is dirt cheap, but also quite toxic. Hence why it is also available as a liposomal formulation which is significantly less toxic. The type of patients who require it are usually very sick with life-threatening infections and wouldn't be able to withstand the toxicity of the conventional drug, so in practice the liposomal drug is nearly always used. It is expensive (because of the complicated manufacturing process), although £30,000 per treatment would certainly be at the far end of the scale. A typical regime of Ambisome for invasive fungal infections would be 3-5mg/kg daily (about £400-£600 a day), although treatment can be quite prolonged, sometimes for a month or more so it can get very expensive. The drugs bill for ITUs would make anyone's eyes water!

drzhivago

Doyle_G wrote: »

Out of curiosity, can anyone tell me why the anti-fungal drug Amphotericin B is such an expensive drug?? I was told by a lecturer that a treatment with it can cost £30,000 sterling!!!!! is this true??

For what condition
For how long

Cancer patients and those with fungal brain infections may end up on prolonged courses, is an expensive drug but not in the same league as some of the chemo products

DrIndy

When a new drug comes on the market - particularily anti-microbials, there is an issue for pharmaceutical companies on how to recoup their R&D money in sales.

For very good reasons - new antimicrobials are kept as the very last line of treatment for many years and only used for highly resistant bugs and normally only in a Infectious Disease setting or ICU.

So pharmaceutical companies are sometimes forced to charge very high rates to keep their manufacturing afloat for this reason.

Look at the prices for Linezolid, Daptomycin Vs Vancomycin (linezolid and daptomycin is kept for backup in case MRSA becomes resistant to Vancomycin or allergy develops).

Compare Tigecycline, aztreonam and Meropenem to others.

Caspofungin has been mentioned (it is second line for therapy). I'm trying to remember the very new antifungal agent launched...

Remember this is also relative cost. If the drug is very expensive but only very few patients actually receive it, then the overall cost remains low.

Compare this to pharmaceutical companies repatenting Aspirin and doubling the cost?

SomeDose

DrIndy wrote: »

Caspofungin has been mentioned (it is second line for therapy). I'm trying to remember the very new antifungal agent launched...

Anidulafungin (Ecalta)?

DrIndy wrote: »

Remember this is also relative cost. If the drug is very expensive but only very few patients actually receive it, then the overall cost remains low.

Indeed. While the "per dose/treatment" cost (and subsequent revenue) for the likes of ambisome, linezolid etc tend to look spectacular on paper, they are a mere drop in the ocean compared to the money generated by chronic medications such as aspirin, statins, anti-hypertensives etc.

flerb22

i heard it was so expensive because of the lipoprotein delivery system to get the drug at reasonable concentrations without horrendous side effects.

if that isnt right then im just going to have to make the general statement

"yeah they are pretty expensive"