Dr. BaumannFiguring out how to charge for the newly FDA-approved deoxycholic acid (Kybella, Allergan) might be a challenging proposition for physicians who elect to offer this new non-surgical treatment. Kybella, a cytolytic drug, which when injected into tissue physically destroys the cell membrane, can be pricey, according to Miami, Fla., dermatologist, researcher and author Leslie Baumann, M.D.
“[Kybella] patients often say, ‘I can get liposuction for that price,’” Dr. Baumann says. “It is important that they realize that this is better than liposuction — less risk, less down time, no compression garments, no scars, no leaking, faster recovery.”
Among the challenges of pricing Kybella is the lack of experience from other countries.
“The U.S. is the first country to have Kybella,” Dr. Baumann says. “In this case, only the investigators, like myself, have experience, and that was in the format of the trial. We injected every four weeks. So, we (the investigators) need to share our expertise.”
Kybella is new, so things could change. But for now, fees among U.S. physicians who offer the therapy vary greatly. According to RealSelf.com, costs in the U.S. for Kybella treatment generally falls between $1,000 to $2,000 but sometimes higher, depending on location.
Dr. Baumann says she can now look at a patient and know how much and how many sessions they’ll need. Because of this, she has been able to set package pricing by using these 3 steps:
1. How Many Sessions?
Knowing how many sessions a patient will need, upfront, will help physicians offering Kybella to manage patient expectations and end up with happy patients, according to Dr. Baumann.
The reality is, one Kybella injection session will most likely not be enough. While patients will see improvement after each session, unless they have only a small amount of fat to treat, they will probably need three to five sessions, she says.
“You take the risk of undercharging them if you are wrong about how many syringes and sessions they will need, but, if you guess correctly, the patient is happier. You also avoid the issue of shopping around for the cheapest price on subsequent injections,” Dr. Baumann says.
The average Kybella dose in clinical trials was 4 cc to 6 cc per session, but that might not apply in every case to the real world clinical setting. Patients in the trials had to meet certain criteria, according to Dr. Baumann.
2. How Much Product?
Kybella grid applied to submental area.
Photo courtesy Dr. Leslie Baumann.Dr. Baumann says there are steps you can take to more accurately predict how much product a patient will need to achieve the desired outcome. First, doctors should draw the area to be treated, apply the grid [pictured] and count the number of dots.
Kythera’s Injection Dose Count table [pictured] illustrates how many vials go along with the number of dots, according to Dr. Baumann.
“I find it easier to remember that one vial has 10 dots and one syringe has five dots. Note, that you inject 0.2 cc per dot and the vial has 2 cc in it; one syringe is 1 cc,” she says.
3. Tiered pricing
Dr. Baumann charges by the syringe or what she calls a three-pack, with tiers. When patients buy the tier upfront, they get a significant discount, she says. She uses the aforementioned approach to predict how much product and how many sessions to inform her patient recommendations.
Dr. Baumann’s tiers include:
- Tier 1: One vial each month for three months.
- Tier 2: Two vials each month for three months.
- Tier 3: Three vials each month for three months.
- Tier 4: Four vials each month for three months.
- Tier 5: Five vials each month for three months.
NOTE: Use of more than five vials per session is not recommended, according to Dr. Baumann.
Disclosure: Dr. Baumann is an investigator for Allergan.
