New York, NY— Goldman Sachs, in an April report to clients, addressed an ethical conundrum facing pharmaceutical and biotechnology companies in regard to futuristic cures based on cutting edge gene therapy: “one shot cures,” rather than the model of continuous treatment, could be difficult for some “medicine developers looking for a sustained cash flow.”

In a report entitled “The Genome Revolution” Goldman Sachs analyst Salveen Richter asked, “Is curing patients a sustainable business model?”

“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients on April 10. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

Richter highlighted the case of Gilead Sciences’ treatments for hepatitis C, which reportedly achieved cure rates of over 90 percent, as a cautionary tale.

“GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients,” the Goldman Sachs analyst wrote. “In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines … Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise.”

CNBC reported that in 2015 the company’s U.S. sales for hepatitis C treatments peaked at $12.5 billion but have fallen each following year. Goldman has estimated that U.S. sales of these treatments in 2018 will be under $4 billion, according to the report.

The report proposed three possible solutions for biotech companies:

“Solution 1: Address large markets: Hemophilia is a $9-10bn WW market (hemophilia A, B), growing at ~6-7% annually.”

“Solution 2: Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe.”

“Solution 3: Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness) … Pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets.”

The issues addressed in the report essentially means that mega-profits will be reduced to extremely large profits— but for more rare diseases, however, there is a concern that due to reduced potential income there may not be enough profits for biotech firms to justify the cost of research and clinical trials, usually at the cost of at least $1 billion.

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