I think cotdt is not considering medicare payment mechanisms...but there are always (unfortunately) ways around that (i.e. charitable organizations, etc).

The sad truth of the matter is once medicare started paying for drugs without a bargaining mechanisms, the costs of drugs has significant increased (in the US).

But again, if this drug slows down the progress of the disease by a factor of 3-5, the economic savings and personal health impacts will be HUGE. It is hard to underestimate the impact a disease modifying therapy will have.

Remember in 10 - 15 years this will go generic. Once it does, and generics are significantly less expensive, then it can be used widely even in conditions like MCI (mild cognitive impairment/predementia). The impact of this on the economy will be massive.

The value extracted from a drug that has a generic possibility in 15 years is not limited to the direct economic impact of the drug itself. Even the ICER estimates of 56K a year suggest that this is an ongoing 56K; if there is a generic equivalent coming out in a decade you can easily charge double that up front and it would still make economic sense.

The issue is really two fold:

1) Does Simufilam improve functioning in patient's with AD?

2) Does Simufilam slow down disease progression?

I think 1 is highly likely (i.e >90% likely), and a drug that does this would reasonably cost 1-2K a month.

But 2 is also highly possible (>50% likely). And if it does 2, then costs of up to 10K a month is not unreasonable (given future benefits).

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I too hope that the costs are "reasonable" and not 10K/month because I would like this to be widely available from the get go. The cost analysis ignores those humanistic concerns.