
The U.S. Health Care System Found a Way to Make Peanuts Cost $4,200 - jawns
https://www.theatlantic.com/health/archive/2019/09/dangers-peanut-allergy-drug/597997/
======
refurb
I know this company well and knew this was going to become a PR issue.
Aimmune's product is just purified peanut flour. Convincing everyone it's
worth thousands (to tens of thousands) of dollars is going to be tough.

That said, you're not paying for the peanut flour, you're paying for the
comprehensive set of data the company had to develop to _prove the product
actually works_.

Just rough numbers, a phase 3 clinical trials costs about $15K per patient per
year. Aimmune ran a year long trial with 1000 patients (from
clinicaltrials.gov), so the trial alone cost them almost $160M dollars. Add in
manufacturing regulations, etc, you can understand why they raised $400M over
the past 8 years since they were formed.[1]

The other thing to keep in mind is the pharmacoeconomic arguments. If
insurance companies are paying thousands of dollars each time a child goes to
the ER for a allergic response, pay $10,000 for this drug to reduce those may
make total sense.

Also interesting that this article comes out the same day the stock is halted
because the FDA review committee is meeting. You can peruse the briefing
document to see what they'll be discussing.[2]

[1][https://www.crunchbase.com/organization/allergen-research-
co...](https://www.crunchbase.com/organization/allergen-research-corporation)
[2][https://www.fda.gov/media/130654/download](https://www.fda.gov/media/130654/download)

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jawns
Obviously, the high cost of the therapy is news in and of itself, and it's
very illustrative of the fact that high R&D costs need to be wrapped up in the
cost of the drug, even if the drug itself costs peanuts to make. (LITERAL
PEANUTS, get it?!?)

But what's more worrisome is that although oral immunotherapy appears to
desensitize patients to the allergen, real-world evidence shows that these
people actually end up experiencing allergic reactions more frequently than
those who practice strict avoidance, the article reports.

Whether that's because the patients who've undergone therapy are letting their
guard down, or because the drug is only semi-protective, is unknown. But the
article argues that the therapy might lead to a net increase, rather than a
decrease, in allergic episodes.

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junar
One of the studies describes the exact doses:

> AR101, a powder, was administered in graduated doses ... from capsules
> containing 0.5, 1, 10, 20, or 100 mg of peanut protein, formulated with
> bulking and flow agents ... Study product was consumed after opening the
> capsules and mixing its content into an age-appropriate, nonallergenic,
> vehicle food (eg, applesauce, pudding).

[https://www.jaci-
inpractice.org/article/S2213-2198(17)30742-...](https://www.jaci-
inpractice.org/article/S2213-2198\(17\)30742-0/pdf)

Their website claims that 1 peanut is 250-300 mg peanut protein.

[https://www.aimmune.com/ar101-peanut-
allergy/](https://www.aimmune.com/ar101-peanut-allergy/)

So while $4,200 might be a bit high, there is probably still some value in
isolating a 1/500 peanut dose.

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m-p-3
In case someone cannot get past the paywall

[https://ipfs.io/ipfs/QmVmaUKkcZwyWRZ5ZyK8MkxDzYPWL4dGdSLrfjN...](https://ipfs.io/ipfs/QmVmaUKkcZwyWRZ5ZyK8MkxDzYPWL4dGdSLrfjNMWNWTt5/)

[https://cloudflare-
ipfs.com/ipfs/QmVmaUKkcZwyWRZ5ZyK8MkxDzYP...](https://cloudflare-
ipfs.com/ipfs/QmVmaUKkcZwyWRZ5ZyK8MkxDzYPWL4dGdSLrfjNMWNWTt5/)

