Even if the cost of Metformin is only 2 cents a day, giving to to 5 billion people every day for 80 years would cost about $3 trillion (0.02*365*80*5*10^9). Whilst the cost would (at least potentially) be distributed across the population, it also seems like something that should be mentioned as a cost of the policy.
It was in fact discussed in section 7.1 there we wrote:
The price of a lifetime supply of metformin, 500 USD, will pay for an additional 1-3 years of life expectancy and a proportional delay of age-related diseases.
However, the actual price of the therapy for a person could be negative, because medical insurance companies will be interested that people will start taking age-slowing drugs, as it will delay payments on medical bills. Insurance companies could gain interest on this money. For example, if 100K of medical bills is delayed by three years, and the interest rate is two percent, the insurance company will earn 6 000 USD on later billing. Thus, insurance companies could provide incentives such as discounts or free aging treatments to those who use antiaging therapies.
I more meant it should be mentioned by the $0.24 figure e.g. something like:
“Under our model the direct cost effectiveness is $0.24 per life saved, but there is also an indirect cost of ~$12,000 per life saved from the cost of the metformin (as we will need to supply everyone with it for $3 trillion, but it will only save 250 million lives).”
Noticeably the indirect figure is actually more expensive than current global poverty charities, so under your model buying people metformin would not be an attractive intervention for EAs. This does not mean it would necessarily not be cost effective to fund the trial to ‘unlock’ the ability for others to buy the drugs, since it might be more efficient than e.g. other developed government use of money, but it does hammer home that the costs of the drugs is very non-negligible.
Yes, but 10kg of pure Metformin powder is not much good since it needs to be packaged into pills for easy consumption (since its needs to be taken in sub gram doses). Since you are not able to find pills for less than 2 cents (and even those only in India) I think you should not assume a lower price than that without good reason.
Presumably we run into some fundamental price to form, package and ship all the pills? I would be surprised if that could be gotten much below 1p per pill in developed countries. (although around 1p per pill is clearly possible since some painkillers are sold around that level)
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
I also not suggesting buying metformin for people. In case of food fortification, the price is probably included into the total price of food and the manufacturers pay lowerest bulk price.
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
Yes but as I discuss above it needs to be turned into pills and distributed to people, for which a 2 cents per pill cost seems pretty low. If you are arguing for fortification of foods with metformin then presumably we would need to show extraordinary levels of safety, since we would be dosing the entire population at very variable levels.
In general I would find it helpful if you could try and keep your replies in the same comment—this basically seems to be an extension of your other comment about buying metformin in bulk and having it split in two makes it harder to keep track.
Ok. I just have two ideas in different moments of time, that is why there are two comments.
I think that again the problem of expensive pills is not a problem of antiaging therapies, but a more general problem of expensive medicine and poverty. I should not try to solve all possible problems in one article as it will immediately grow to the size of the book.
Most drugs we now consume are overpriced compared with bulk prices; also food is much more expensive in retail. I think it is important problem, but it is another problem.
I’m not saying you need to solve the problem, I’m saying you should take the problem into account in your cost calculations, instead of assuming it will be solved.
In the next version of the article, I will present general equation in which will try to answer all these concerns. It will be (price of the experiment)(probability of success) + indirect benefits of experiment - (fixed price of metformin pills for life)(number of people)(share of adopters)(probability of success of the experiment) - unexpected side effects—growth of food consumption because of higher population. Anything lost?
I’m not quite sure what this equation is meant to be calculating. If it is meant to be $ per life saved it should be something like:
Direct effects:
(price of the experiment)/((probability of success)*(lives saved assuming e.g. 10% adoption))
(Note the division is very important here! You missed it in your comment, but it is not clear at all what you would be estimating without it.)
Your estimate of the indirect costs seems right to me, although in the case of:
growth of food consumption because of higher population
I would probably not include this level of secondary effect, since these people are also economically productive etc. so it being very hard to estimate.
Even if the cost of Metformin is only 2 cents a day, giving to to 5 billion people every day for 80 years would cost about $3 trillion (0.02*365*80*5*10^9). Whilst the cost would (at least potentially) be distributed across the population, it also seems like something that should be mentioned as a cost of the policy.
It was in fact discussed in section 7.1 there we wrote:
The price of a lifetime supply of metformin, 500 USD, will pay for an additional 1-3 years of life expectancy and a proportional delay of age-related diseases.
However, the actual price of the therapy for a person could be negative, because medical insurance companies will be interested that people will start taking age-slowing drugs, as it will delay payments on medical bills. Insurance companies could gain interest on this money. For example, if 100K of medical bills is delayed by three years, and the interest rate is two percent, the insurance company will earn 6 000 USD on later billing. Thus, insurance companies could provide incentives such as discounts or free aging treatments to those who use antiaging therapies.
Medical expenses are wayyy lower in the developing world.
At the time when metformin will reach these markets as a life-extending drug, may be somewhere in 2040, these market will develop.
I more meant it should be mentioned by the $0.24 figure e.g. something like:
“Under our model the direct cost effectiveness is $0.24 per life saved, but there is also an indirect cost of ~$12,000 per life saved from the cost of the metformin (as we will need to supply everyone with it for $3 trillion, but it will only save 250 million lives).”
Noticeably the indirect figure is actually more expensive than current global poverty charities, so under your model buying people metformin would not be an attractive intervention for EAs. This does not mean it would necessarily not be cost effective to fund the trial to ‘unlock’ the ability for others to buy the drugs, since it might be more efficient than e.g. other developed government use of money, but it does hammer home that the costs of the drugs is very non-negligible.
Also, Alibaba suggests metformin for 5 USD for kg, which implies lifelong supply could be bought for something like 50 USD.
https://www.alibaba.com/product-detail/HOT-SALE--99-High-Purity_50033115776.html?spm=a2700.7724857.main07.53.2c7f20b6ktwrdq
Yes, but 10kg of pure Metformin powder is not much good since it needs to be packaged into pills for easy consumption (since its needs to be taken in sub gram doses). Since you are not able to find pills for less than 2 cents (and even those only in India) I think you should not assume a lower price than that without good reason.
Presumably we run into some fundamental price to form, package and ship all the pills? I would be surprised if that could be gotten much below 1p per pill in developed countries. (although around 1p per pill is clearly possible since some painkillers are sold around that level)
Also, the global market for snake-oil life extension is 300 bn a year, so spending 10 times less would provide everybody with actually working drug.
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
I also not suggesting buying metformin for people. In case of food fortification, the price is probably included into the total price of food and the manufacturers pay lowerest bulk price.
Yes but as I discuss above it needs to be turned into pills and distributed to people, for which a 2 cents per pill cost seems pretty low. If you are arguing for fortification of foods with metformin then presumably we would need to show extraordinary levels of safety, since we would be dosing the entire population at very variable levels.
In general I would find it helpful if you could try and keep your replies in the same comment—this basically seems to be an extension of your other comment about buying metformin in bulk and having it split in two makes it harder to keep track.
Ok. I just have two ideas in different moments of time, that is why there are two comments.
I think that again the problem of expensive pills is not a problem of antiaging therapies, but a more general problem of expensive medicine and poverty. I should not try to solve all possible problems in one article as it will immediately grow to the size of the book.
Most drugs we now consume are overpriced compared with bulk prices; also food is much more expensive in retail. I think it is important problem, but it is another problem.
I’m not saying you need to solve the problem, I’m saying you should take the problem into account in your cost calculations, instead of assuming it will be solved.
In the next version of the article, I will present general equation in which will try to answer all these concerns. It will be (price of the experiment)(probability of success) + indirect benefits of experiment - (fixed price of metformin pills for life)(number of people)(share of adopters)(probability of success of the experiment) - unexpected side effects—growth of food consumption because of higher population. Anything lost?
I’m not quite sure what this equation is meant to be calculating. If it is meant to be $ per life saved it should be something like:
Direct effects: (price of the experiment)/((probability of success)*(lives saved assuming e.g. 10% adoption))
(Note the division is very important here! You missed it in your comment, but it is not clear at all what you would be estimating without it.)
Your estimate of the indirect costs seems right to me, although in the case of:
I would probably not include this level of secondary effect, since these people are also economically productive etc. so it being very hard to estimate.