高盛在生物科技报告中提问:治愈病人是一种可持续的商业模式吗?
Goldman Sachs asks in biotech Report: Is curing patients a sustainable business? (2018)

原始链接: https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html

高盛分析师最近对基因疗法的长期商业可行性表示担忧,尽管该疗法有潜力提供“一次性治愈”。他们的报告《基因组革命》质疑治愈患者是否是一种*可持续*的商业模式,因为它消除了慢性病治疗常见的持续收入来源。 该分析指出吉利德科学公司在丙型肝炎治疗方面的经验——2015年最初是一个125亿美元的市场,现在预计将降至40亿美元以下,原因是患者数量减少。虽然治愈对患者和社会有益,但这对寻求稳定现金流的生物技术公司构成了财务挑战。 高盛建议三种策略来缓解这一风险:瞄准大型市场(如血友病),关注高发病率疾病(如脊髓性肌萎缩症),以及优先进行持续创新和投资组合多元化,以抵消治愈疾病疗法收入的下降。最终,该报告强调了基因治疗领域中医疗进步与财务可持续性之间可能存在的冲突。

## 高盛报告:治愈患者与可持续商业 (2018) 2018年的一份高盛报告引发了Hacker News上关于治愈患者是否是一种可行的商业模式的讨论。核心论点是,虽然治愈疾病在伦理上是可取的,但它消除了治疗这些疾病带来的持续收入来源,这使得以盈利为中心的制药公司不太感兴趣。 评论者对此进行了辩论,指出治愈方法仍然可以非常有利可图(以吉利德的丙型肝炎药物为例),并且治愈的人口总体上对社会有更大的贡献。另一些人强调了解决大市场和持续创新的重要性,以抵消治愈方法出现后的收入损失。 一个关键点是需要考虑“二阶效应”——健康人口带来的更广泛的经济效益。许多人认为,政府资助可能更适合治愈方法,因为它们并不总是与纯粹的盈利动机相一致。讨论还涉及了制药行业的复杂性,包括专利期限、仿制药竞争以及为了持续收入而优先管理症状而非治愈的潜力。最终,争论的中心在于,优先考虑利润是否会固有地阻碍对治愈方法的追求。
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原文

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Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering "gene therapy" treatment: cures could be bad for business in the long run.

"Is curing patients a sustainable business model?" analysts ask in an April 10 report entitled "The Genome Revolution."

"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 Tuesday. "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 cited Gilead Sciences' treatments for hepatitis C, which achieved cure rates of more than 90 percent. The company's U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year, according to a table in the report.

"GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients," the 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."

The analyst didn't immediately respond to a request for comment.

The report suggested three potential solutions for biotech firms:

"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."

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