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Vinay Prasad MD MPH Profile picture
@VPrasadMDMPH
Dec 21, 2021 • 8 tweets • 3 min read • Read on X
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In our new paper in @JAMANetworkOpen we take a deep look into cost-effectiveness (CEA) studies of cancer drugs

Bottom line: If a CEA study is funded by pharma, it is 40x (OMG!) more likely to find the drug is cost effective

A 🧵 explaining what we found
jamanetwork.com/journals/jaman…
For every cancer drug indication approved between 2015-20, we searched for cost-effectiveness studies

we found between 0 and 9 per drug!!

Some trials were industry sponsored & others neutral
Here are the baseline characteristics of the studies we looked it.

Only 1/2 to 2/3 of drugs have even shown they improve survival

The rest have unknown effects on survival

That is not good enough

It is FDA failure! (these days that's common)
In descriptive analysis, 96% of industry sponsored studies find a drug is cost effective, while this is only true for 30% of non industry sponsored studies

Don't worry! I bet the authors of the 4% of studies sponsored by pharma finding it not cost effective have been fired.
In a multivariate model, being funded by pharma is associated with an odds ratio of 40!!! that a study concludes a drug is cost -effective

This relationship is MASSIVE

Tobacco as a lung carcinogen is only OR 20!!!
Finally, here is a waterfall plot of the incremental cost-effectiveness of drugs BEYOND the threshold

Some cancer drugs are 1 MILLION dollars per QUALY beyond the threshold!!!

This is madness!
We spend so much on drugs that either (a) don't improve survival or quality of life (b) we don't know if they do or (c) do so only marginally

No society can exist funding these drugs

It is untenable

It will bankrupt us all
They say Rome collapsed when half of all days were holidays; perhaps the same fate will happen in the USA when half of GDP is spent on cancer drugs that don't work or work marginally

Read the full paper here:
jamanetwork.com/journals/jaman…

& Follow @vkprasadlab for research updates

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More from @VPrasadMDMPH

Vinay Prasad MD MPH Profile picture
Nov 29, 2024
Here's what they are not saying
Vaccine hesitancy has been rising for some time. This includes preventable illnesses like measles. There will be measles outbreaks in the future! Covid policy accelerated hesitancy. The question is: how many extra outbreaks will occur bc of RFK...
... If RFK is HHS secretary, versus if RFK is not HHS secretary. That's the question.

Even though he has tremendous administrative authority, he has already stated he's not going to withdraw these vaccines. I also suspect it's not going to be the first topic he touches...
Moreover, I and others have repeatedly provided compromised positions where we can improve safety detection of current vaccines. The current system can be honest and admit that our vaccine surveillance is abysmal. Companies don't want safety discovered.
Read 9 tweets
Vinay Prasad MD MPH Profile picture
Nov 22, 2024
Every single one of these garbage papers use the denominator of PCR+ covid infections, and not the actual denominator of people who had covid-- many do not present to the doc. Every single one of these papers is shit. I would be embarrassed to be an author. Incompetent work. Image
People with covid who are so sick they have to go to the doctor have poorer health than people who don't. That should be in the journal of obvious things. All of these authors are extrapolating beyond the evidence. They're creating a body of trash calling itself science
Is there a single paper that uses a sero prevalence denominator? Is there a single researcher in this field whose brain is working? Just one. That's all I ask for.
Read 7 tweets
Vinay Prasad MD MPH Profile picture
Oct 3, 2024
Totally wrong. Because Vincent is not thinking about the counterfactual correctly.
*Teachable moment*

1 These drugs were approved by accelerated approval in the LAST line. Some later improved survival & others didn't in an EARLIER line.

2 The counterfactual to AA... 🧵
is demanding RCTs powered for say, OS (survival). If a company couldn't use RR to get AA, they wouldn't run a trial in the 2nd line or 3rd line setting powered for OS, they would run it in the 7th or 8th line

Why? more dire = faster result
3. We have proven that in these v late lines RR and median DOR (the current AA criteria) result just as fast as OS
pubmed.ncbi.nlm.nih.gov/30933235/
Read 10 tweets
Vinay Prasad MD MPH Profile picture
Sep 29, 2024
Many people want covid to be worse than it is. They imagine it has long-term consequences that are worse than other respiratory viruses. Adjusting for severity of illness, it doesn't. Only anosmia is unusual. Why do they want it to be worse than it is? 🧵
For some reason, some people want to live with perennial precautions. They don't want to take off the mask, they want their children to mask, they want to keep getting booster after booster. I don't know why but they want to live in fear.
They have...
A mountain of retrospective observational data that they think supports their claim that covid has long-term disability. That it's a vascular disease. And all sorts of other claims. Nearly all these studies are flawed. They don't have good controls.
Read 15 tweets
Vinay Prasad MD MPH Profile picture
Sep 25, 2024
I spent a lot of time today reading this paper, the criticism, the rebuttal, the retraction notice. OMG! My head hurts.

But... An important point no one has said is that the entire premise of the study & criticism is flawed. 🧵 Here is a short summary
Lots of prior studies show many psychological findings don't reproduce. Obviously that's because so much of this science is bullshit. Small sample size, weak methods. Entire fields struggling to justify their existence & people p hacking and exaggerating to be on @HiddenBrain
How do you fix this problem? No one really knows. All of academia is incentivized for hype and discovery, actually being a thoughtful student, criticizing things, pushing for better methods that's unpopular.
Read 17 tweets
Vinay Prasad MD MPH Profile picture
Sep 14, 2024
Thank you @Erman_Akkus for ur reply it is a good learning opportunity for #ESMO24

In 15 tweets, I will summarize the trial, my criticism, and why this reply contains 3 common errors that oncologists make because our training doesn't teach these ideas.

First, the trial... Image
The trial is #LEEP-012 and randomizes pts with INCURABLE (see pic) liver cancer to TACE (embolization) plus costly drugs or embolization alone.

These 2 drugs are TOXIC (lenva is horrible) and cost a FORTUNE 200-300k per annum per person
#ESMO24 Image
Every single person has the cancer return. It is non-metastatic, as @Erman_Akkus says, but it is not curable.

Here is the time until measured lesions grow 20% or new lesions present or the patient dies

That's what he and others are excited by #ESMO24
a 4 months PFS Image
Read 16 tweets

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