I'm a physician, the following is my opinion, so take it with a grain of salt
metronidozole is first line treatment, metronidazole is cheap,
vanco is second line, it cost about 1500 bucks for the treatment
Dificid is third line, costing about 2600 bucks for the treatment
if metro doesn't resolve the infection, I believe the second line will become Dificid, the reason is that the chances of cures with vanco are much less after metronidazole failure, now if Vanco was used first, then cure rates would be higher and Difcid use might be further limited
however since metro is used first and if failure happens, doctors sooner or later will bypass vanco and go straight to Dificid, hospitals will make sure doctors do that because 1100 dollars difference between vanco and dificid is nothing compared to the cost of readmission, not to mention potential lives saved
what will happens in the future?
as a hospitalist, I am evaluated by my length of stay and readmissions, in fact, I will be fired if my patients stay in the hospital longer than average, C.Diff will become, if not already, the primary hospital acquired infection, you can bet, if given a choice between metro, vanco and Dificid, I will use dificid, as far as I know, medicare pays the hospital a flat rate per case, since there is a flat rate, it's just a matter of calculating numbers in deciding which treatment is worth the money and lives saved, I believe if metro starts failing, then Dificid will become number one and not vanco, but most private insurances pay fee for service or per diem, this type of payment leaves the decision making up to the doctors and the hospital, in this case, Dificid will most likely become first line of treatment for C.Diff treatment
thus, I think vanco will become exluded from the treatment options eventhough it is an effective second line agent
I think the company management knows that, I believe the large investment institutions know that as well, this company has a lot of reserve cash and they have spent a ton of money on infrastructure and rep marketing to doctors and hospitals, if they dont run out of cash, this company will likely become successfull, I still think Pedro is making the right decisions based on a calculated risk
Check with your hospital pharmacy department. Vancomycin capsules are never dispensed nor metronidazole (complicated dosing regimen). Vancomycin oral suspension made from vancomycin iv powder is what is dispensed at $1 per dose. In either case, fidax is never first line agent.
you are right, vanco powder is 5 bucks a dose, but vancocin po is 1500 bucks for a 10 day regimen
it all boils down to recurrence and persistant disease
the only way 2600 dificid price tag can be justified is if it prevents deaths and effectively treats and cures the vanco failures, and/or prevents rehospitalizatoins and further length of stay, this is all to be determined
once again, this message was my opinion, it's not facts or based on clinical trials, it's just an opinion
in long term facilities, vanco is going to be used over and over again, or maybe at least twice because the patients are not going anywhere, and if vanco keeps failing, they will use Dificid, that's if the patient is still has a colon and is alive from raging persistant C.Diff, but any humane nursing home will eat the costs and treat with Dificid
but in an acute hospital setting, I believe this is where the money is, despite vanco and metro being very cheap, will the hospital fork over 2600 bucks to avoid deaths, surgeries, readmissions which cost the hospital much much more than 2600 bucks? I believe the answer will be yes after thorough financial analysis
one more thing, the proposed payment systems will penalize hospitals for re-admissions due to a recurrence of C.Diff, this will give further incentive for hospitals to use Dificid
on a side note, to the person named jreality or whatever his or her name is , there are 99 hospitals in the USA that have Dificid on their formulary and some of them have it as their first line agent, do a search on the internet, you will find them out
with all said, this company does have a speculative aspect as well an an investment aspect, but after enough research and knowledge, if you know what you are doing (I am not saying I know what I am doing), the speculative aspect becomes less of a risk
I hope I am right being long on this stock
only time will tell, I just hope they dont run out of money
doc just curious, you say -> "I believe the second line will become Dificid, the reason is that the chances of cures with vanco are much less after metronidazole failure, now if Vanco was used first, then cure rates would be higher and Difcid use might be further limited."
what makes vanco much less of a cure than dificid after a metro failure? any clinical basis on dis? did dey do a trial comparing vanco and dificid after metro treatment and failure?
so if vanco becomes first line through da introduction of cheap generic, dificid will only see limited use?