V1,
Agree with your central argument that convenience and perhaps cost are being overvalued in Bex v. Rit/Zev analysis, but two observations:
<<Many expert believed Crix would maintain its dominance because of MRKs marketing muscle even though Viracept was a superior molecule. Wrong. Viracept won in part because of patient knowledge and demand.>>
Actually in terms of naked efficacy they're pretty similar. And everyone assumed that was the only factor and thus MRKs marketing muscle would win the day. AGPH ACTIVELY marketed lower side effects (and the ability to actually tolerate Viracept, thus higher compliance and probably higher practical efficacy). Lesson one (IMO): When efficacy is arguably the same, look to side effects. Lesson two: The appropriate marketing message does need to be pushed (and hopefully SKB/CLTR have that nailed) even with an informed patient advocacy. Lesson three: Now that more varied ARV options make side effects manageable with viral suppression for many HIV patients, we have moved on to convenience (less frequent dosing, combination dosing) in some cases.
But ARVs are chronic medications, unlike chemo+radioimmunotherapy, and we are not yet to the efficacy/side effect point where convenience becomes the driver. If convenience is going to be the marketing message behind Zev, perhaps someone should send IDPH a copy of Maslow's hierarchy.
<<analysts focussed on convenience. I believe it is because they are talking to doctors who might rank convenience and cost quite a bit higher than the patient.>>
You also have to wonder how they asked the question. If they truly looked at trade-offs between efficacy, side effects and convenience in a statistically sound way, I'd be really surprised if they found convenience to be so important. I suspect they're asking the physician, "Hey, how much would it matter to you if you didn't have to do dosimetry?" Try asking it as, "Would you be willing to kill 10% more of your patients (or even have them just have progressive disease for another year) to avoid dosimetry?" It won't just be the patients who demand better CR rates.
Of course third-party payers will have to be convinced on the economics, and I don't know how those will finally look, but in most calculations end-stage disease is an expensive outcome.
biowa |
