Medicine: The High Cost of Clotting

“A large bill like this is going to be a severe jolt to anyone, regardless of financial circumstances,” says a neat card prepared by Cutter Laboratories of Berkeley, Calif, and handed out last week by doctors to patients or their kin. And with good reason: Cutter was talking about bills for one of the highest-priced medications currently in general use—fibrinogen, a fraction of human blood. Fibrinogen restores the clotting power of blood, which may almost vanish when a woman hemorrhages during labor, or in patients of either sex after major surgery. Average cost of fibrinogen to the patient: $50 to $55 a gram (1/30 oz.). Average amount used in a single course of treatment: 4 gm.

Cutter, which markets fibrinogen under the trade name Parenogen, packs an explanatory card with every gram. On a tear-off part aimed at physicians, it urges: “Make sure that this gets to the one who pays the patient’s bill, preferably at the time of injection or when the bill is presented. The costliness of Parenogen will come as a shock and will surely be resented unless it is fully understood. Help avoid this unnecessary resentment by seeing that this gets to the bill payer.”

The attached explanation pointedly notes that many unfortunate patients bled to death before fibrinogen was available, goes on to make its point: “It is extremely expensive to prepare, because to treat an average patient it requires blood from approximately 25 paid professional donors and more than three months of careful processing and testing by highly trained technicians. Because this is a truly lifesaving product, we felt we must, in all conscience, make it available. It was not up to us to decide that $50, $100, $200 or even more (depending upon the amount of fibrinogen needed) is too high a price for a man to pay to save his wife’s life, or his own.”

Concludes Manufacturer Cutter (which gets $32.91 for a r-gm. injection kit, leaves the service markup to the discretion of the hospital): “We wanted to explain the high cost of the product, even if we could not make the bill any easier to pay.”