Fight Aging!

It is useful to think about the potential cost of future longevity therapies in the clinic - and changes in that cost over time - and compare this with the value people place on the results. This sort of exercise can help guide our expectations on commercialization: how long will it take for companies to form and deliver laboratory results to the clinic?

Progress is a matter of incentive. If you have the new science to produce a super-widget for $1 that happens to solve a common problem that people value at $100 of inconvenience, then the world will beat a path to your door. There won't be any path-beating going on if your super-widget costs $1000, however, save for some far-sighted people who think they might, maybe, be able to cut down the super-widget cost to a point at which it makes sense to sell it.

Incentives make the world go round.

So on to longevity therapies, where the math is more fuzzy. The value placed on healthy life in the developed world is the better known side of the equation:

So, how much is your life worth? You may think the answer is infinity, that no amount of money could compensate you for the loss of your life. But people do put a price tag on their existence. Workers accept riskier jobs for higher pay, for example. And the rich tend to think their lives are worth more than poor people’s.

Studies of real-world situations produce relatively consistent results, suggesting that average Americans value a year of life at $100,000 to $300,000, said Peter J. Neumann, director of a program at Tufts-New England Medical Center that measures the cost-effectiveness of new treatments.

That's mid-2007 dollars, so adjust accordingly. On the longevity therapy side, we have to look at anticipated benefits rather than actual benefits. No-one will know for certain the benefits of longevity therapies - in terms of additional years of healthy life, and varied effects between patients - for decades following their introduction. Value will be estimated by the marketplace from the available information, such as effects on biomarkers of aging, comparison with known biology, related therapies, and the like, and that value will move over time as estimates are adjusted for new science and new data.

So let's take the hypothetical of a longevity therapy that the consensus believes will add ten healthy years to the average life. Replacing age-damaged mitochondrial DNA might do that in humans, for example. This suggests that to bring a first widespread commercial version to the high-end medical practices of the world, the price tag on the therapy has to be brought down below $1-3 million, or the value of a decade of healthy life.

There are plenty of entities in the marketplace that sell goods and services to wealthy individuals at this sort of cost; you can build a profitable business on these figures, especially if the cost is paid over years. So I think that a fairly brief stage of expensive longevity clinics is to be expected in the early development of working methods to repair age-related damage in the body. I say brief, because the cost of medical services tends to fall fairly rapidly to a minimum set by the wages of the specialist staff involved. High prices in the beginning allow investors to profit by their investment, while also acting as a beacon for other businesses to enter the market, and prices then fall with competition and increased development and efficiency fueled by ongoing re-investment of profit.

The stable state for a medical treatment is that in which many specialist staff are available, and a competitive marketplace exists to train those staff and supply needed raw materials. At that point, the cost is much the same for medical procedures across the tiers of specialist labor and complexity - it's largely down to the wages of those folk performing the work.

Replacing mitochondrial DNA should be a hands-off outpatient procedure, once the technology is mature. Have a sample taken, send it off to the lab to work up a repaired genome and the viral vector, get injected with the vector that will replace your mitochondrial DNA with repaired versions, and then come back for regular testing for a couple of months. That is nowhere near as labor intensive as, say, heart surgery today. So one could look at comparable procedures that require supporting individual lab work on the back end, such as limited genetic testing, and take a stab at the price tag in the $10-30,000 range.

That's a hundred times smaller than $1-3 million, which seems fair for the progression from early version to mature technology, especially in this age of rapidly advancing biotechnology. It's also a hundred-for-one bargain on the consensus expectation of value of life gained, which is a pretty good deal - good enough to tempt a very broad customer base, and enough profit for a large and competitive industry to form.

The interesting question is how long it will take to get from point A (millions of dollars, hundreds of customers) to point B (tens of thousands of dollars, millions of customers). That's very much determined by the level of competition and regulation - is it easy to enter the marketplace? Is it easy to market new versions of the technology? Sadly, the answer in medicine is "no." Government employees work very hard to slow down progress, add cost and stifle competition. That's going to have to change if we want to see effective, widespread longevity medicine in our lifetimes.

The last thought for the day: regular exercise might just add a decade of healthy life, and I could argue for that as an expected benefit, even prior to the studies of the past decade. How much do you think average enthusiasts spend on the tools and perks of organized exercise over a lifetime? $10-30,000 perhaps?