Regarding my post entitled “Imagine”

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biopearl123
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Regarding my post entitled “Imagine”

Post by biopearl123 » Wed Nov 30, 2022 12:31 am

Michael on YMB suggested my Imagine post could be construed as a “pump”. I assure you it was based on numbers readily available in the Dr. Platzbecker abstract. The range of pre treatment TR was between 4 units every eight weeks (24/year) and 14 every eight weeks (84/year) with a median of 6 units every 8 weeks or 3 units a month with a broad range as noted. So if we take 3 units a month (understanding that some patients have a much higher transfusion requirement), that’s 36 transfusions/year/patient. Not every patient’s TR went to zero but we know from previous presentations that responders still had some benefit in the neighborhood of 65% HI, so that’s more transfusions saved. This abstract presents 11 patients with sustained transfusion independence. So this small group alone did not need about 396 transfusions over the course of a year. This does not include other patients who just showed a decreased transfusion requirement. Kmall (and most certainly Mr. Kapur) have done the math previously to look at total numbers of transfusion dependent patients with MDS who could benefit from Imetelstat. Pretty sure that works out to be a big number. Phase III confirmation will be required by the heme/onc community as well as the FDA. We will have that in early January. Best wishes, bp. (This stands for biopearl, not “big pump”.

kmall
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Re: Regarding my post entitled “Imagine”

Post by kmall » Wed Nov 30, 2022 7:29 am

If memory serves me correct here, I believe it was somewhere in the neighborhood of 400,000+ units of blood/yr in LR-MDS patients.

Keep in mind, this was just the "estimated global patient population" that is referenced and ONLY includes the US and top 5 European countries - UK, Italy, France, Germany and Spain.

It's most likely at minimum double or triple that, since more than half of Europe, Africa, The Middle East, Asia (India & China with 2B+), South America, Canada, Mexico, Central America, Australia and the "rest of the world" aren't factored into those patient estimates which are the basis for many estimates, including potential annual revenue stream projections. -Kmall

Bridge to Sell
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Re: Regarding my post entitled “Imagine”

Post by Bridge to Sell » Wed Nov 30, 2022 1:01 pm

It would be interesting to find out what the average cost of a transfusion is. In that way, we could look at the potential savings to insurance companies and compare it to what we believe Imetelstat will cost when commercialized. Of course the tricky bit is adjusting for the actual prices that insurance company's pay, but either way it would be interesting to see if Imetelstat has potential cost saving as well as life saving advantages.

biopearl123
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Re: Regarding my post entitled “Imagine”

Post by biopearl123 » Wed Nov 30, 2022 3:35 pm

Bridge, now that is an interesting question that engenders a deep dive a la the butterfly effect. Since we are talking about hundreds of thousands of transfusions, analysis has to begin way before blood is collected, conditioned, stored and transfused not to mention costs related to what happens post transfusion. For example, the donor gets up and drives or takes transportation to a place where the blood is collected. He has gas expense or public transportation/wear and tear on his car/maybe he has an accident/there is a contribution to pollution etc. Maybe he pays for parking. He/she/they get to the collection site which has electricity/heat/air/rent/mortgage/hospital gown/insurance, cost of tubing/bag/preservatives/needle/nurse/technician all before the blood is even collected or given to another patient. Maybe the donor missed some work. The nice white haired volunteer ladies give the donor cookies and orange juice. Maybe he gets dizzy and had to stay in the donor facility for a while.He uses the bathroom, flushes the water, washes his hands. All incur costs. You get the picture. Every expense adds up and needs to be factored into the cost to society/insurance/Medicare. This is before transfusion is administered to the needy patient who also incurred expenses just getting to wherever the transfusion is administered and missed time with family and friends (quantify that one!). Then there is the cost associated with an occasional transfusion reaction or transmissible disease from the transfusion (very rare, very expensive). Then the longer term iron overload problems which I wont detail here. Then the risk of worsening disease, more transfusions, transformation to AML, more hospitalizations, funerals, the transportation costs/food/caskets (not trying to be morbid, just making a point) for all the attendees. OK so my only point is that its not just the cost of the transfusion. There is a butterfly effect and it is quantifiable and will likely be used to justify the cost of the drug and the analysis has to how society would benefit. You could probably add fifty more things to this list and not be done. In the meantime what if the patient just feels better (more on that later) and is more productive and lives longer and better (yet to be definitively proven) and didnt need that transfusion after all? So what is the actual cost of a transfusion? You can be sure someone has worked it out to the penny. Each small cost added up and will be multiplied by the hundreds of thousands to demonstrate potential savings to society and improvement in patients lives. Please add your thoughts and analysis. Regards, bp

jingledsassy
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Re: Regarding my post entitled “Imagine”

Post by jingledsassy » Wed Nov 30, 2022 3:46 pm

Back in 2011 2 different transfusions at 2 different hospitals for my wife were both billed about 150k included 7 days ICU for both....The insurance co paid about 50k to each billing, don't remember the breakdown of costs.....the third transfusion at the Mayo Clinic in Minn billed about 50k for same ICU and transfusion and thats what the insurance co paid......

Bridge to Sell
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Re: Regarding my post entitled “Imagine”

Post by Bridge to Sell » Wed Nov 30, 2022 4:24 pm

BP- You make some great points but we can't forget that Imetelstat is a regular transfusion as well, so many of the costs you mentioned probably are replicated while on treatment. I do wonder though if these high transfusion burden patients take a disproportionate share of available blood bank resources, thereby driving up demand for blood and potentially creating scarcity or increased costs at least.

Bridge to Sell
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Re: Regarding my post entitled “Imagine”

Post by Bridge to Sell » Wed Nov 30, 2022 4:28 pm

jingledsassy wrote:
Wed Nov 30, 2022 3:46 pm
Back in 2011 2 different transfusions at 2 different hospitals for my wife were both billed about 150k included 7 days ICU for both....The insurance co paid about 50k to each billing, don't remember the breakdown of costs.....the third transfusion at the Mayo Clinic in Minn billed about 50k for same ICU and transfusion and thats what the insurance co paid......
Thanks you, that's a helpful metric. I'd be curious to see other examples of transfusion billing. My understanding is that 4 to 6 units is the equivalent of replacing all of the blood in the average human's body. It certainly puts into perspective the efficacy of Imetelstat vs Luspatercept which has efficacy mainly in patients receiving a much less massive transfusion. I know it's been written before, but it truly is a huge difference in disease progression between someone who needs half (or less) of their body's blood replaced versus someone who needs it ALL replaced, and as frequently as monthly.

biopearl123
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Re: Regarding my post entitled “Imagine”

Post by biopearl123 » Wed Nov 30, 2022 4:58 pm

Bridge, agreed. There are definitely costs associated with the infusion of Imetelstat that need to be “subtracted out” but that is a risk benefit analysis that should come down hard on the side of drug. You can give a drug infusion through a 21 gauge needle but you will lyse a lot of red cells if you try that. Of course an oral agent once developed would factor out infusion costs.

Bridge to Sell
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Re: Regarding my post entitled “Imagine”

Post by Bridge to Sell » Wed Nov 30, 2022 5:17 pm

Agreed. I asked Dr. Scarlett in person during the last annual shareholder meeting before Covid about an oral version. He was adamant that it would require a return all the way back to Phase 1, so their emphasis was going to be on the transfused version until after FDA approval. We was quite gracious with his time and we spoke for about 15 minutes afterward.

Even though the call was being simulcast online and the phones, I recorded the entire thing in person. The upside was that I managed to catch his conversation with me as well, which occurred after the call formally ended. There's another long-suffering poster on Seeking Alpha and YMB who was in the room as well and we continue to chat to this day. He can verify what I say for those that don't chose to take me at my word.

kmall
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Re: Regarding my post entitled “Imagine”

Post by kmall » Wed Nov 30, 2022 11:10 pm

Far to many variables to form an accurate estimate of cost savings. One of the biggest flys in the ointment is global patient population figures which are easily double or more from what are projected.

Take a look at AML patients and the treatment costs associated with for example:

From: "Go Big or Go Home – Pt.3 (2) – Imetelstat’s Potential Market Size - AML"
viewtopic.php?f=1&t=977

"This 2018 study, published in the AJMC, places the median AML treatment cost per patient / “episode” at anywhere between $329,621 and $53,801……..now these are per “EPISODE” figures !!! Some patients can have more than one of these per year.
https://www.ajmc.com/journals/evidence- ... st-of-care


Average cost of AML treatment per patient / year ($US) - $280,788 - $544,178*
*Based on this 2017 cost evaluation by Celgene
https://www.celgene.com/aml-treatments-costs-value/


For LR-MDS we took a look at this question several years ago. It was estimated that just transfusion costs alone would save between $250 - $400M.
That was just US and the top 5 European countries and also pre-Covid healthcare costs. We could easily double or triple that and still probably be off by a significant amount when all factors are added in. It's most likely $1B+ in annual savings. It's something that countries with subsidized healthcare and insurance companies need to consider. -Kmall

biopearl123
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Joined: Fri Jul 20, 2018 5:13 pm

Re: Regarding my post entitled “Imagine”

Post by biopearl123 » Thu Dec 01, 2022 12:01 am

Kmall, yes I remember our back of the napkin calculations of a few years ago. Given the job descriptions of the recent hires and the one still pending, Geron plans to expand the market or at least ferret out as many appropriate patients as possible. The ultimate attractor could be life extension/less progressive disease as well as symptom control (inflammation effect as discussed previously). I think there will be more to the story soon with strong arguments in favor of earlier treatment.

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