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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
Apr 10
Everything in this thread is incorrect. Literally every recommendation. Here's a thread why. 1/7
There's not a single randomized controlled trial that shows people who undergo a coronary artery calcium test live longer than those who do not undergo it. Everyone will benefit from increasing exercise and eating better and the score is irrelevant
Maybe the only cancer screening test that has any utility under 35 is the pap smear. Mammography doesn't improve survival at any age, and has no data in this age group. Totally crazy recommendation
Read 8 tweets
Vinay Prasad MD MPH Profile picture
Jan 9
Glad that we @vkprasadlab have published over 20++ peer reviewed papers on COVID19 policy to date & many more to come

I will share them here & a free link to all of them at end

We see policy failure

#1 visitor restriction
It was sad to separate family from dying people, & had no dataImage
Cloth masking 2 year olds was an unforced error by @cdcgov and @AmerAcadPeds, who pushed this policy with no credible data, and despite its obvious silliness Image
Long COVID is an evidence based disaster
There is a strong narrative that is not well supported by the evidence.

To date, besides anosmia, there is no evidence COVID has any more long symptoms than being equally ill with any other respiratory virus. period. Image
Read 23 tweets
Vinay Prasad MD MPH Profile picture
Dec 28, 2023
A new 22 page essay by Mariana Barosa, @ID_ethics and me!

"We argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies"
🧵
link.springer.com/article/10.100…
Image
Our essay reimagines the status quo. Instead of implementing and deimplementing and never knowing the answer, Public health must work to reduce uncertainty.

Shown nicely in Figure 2 Image
We discuss many Non pharmacologic interventions tried and their limited evidence

This table represents an evidence based disaster. Nearly none of these were tested with proper trials
Forget beach closures and taking the swings out of parks Image
Read 9 tweets
Vinay Prasad MD MPH Profile picture
Dec 10, 2023
When I read an #ASH23 abstract that asks whether PFS or MRD is a surrogate endpoint in FL (L) or CLL (R), I know instantly the person on the left did it right and the person on the right messed up

Want to learn how?
& diff btw
Prognostic, predictive & surrogate
#Tweetorial Image
When it comes to biomarkers there are 3 categories
Prognostic
Predictive &
Surrogate
#ASH23
jamanetwork.com/journals/jama/…
Image
A prognostic marker means that the marker is associated with a better or worse prognosis in a cohort of patients

For, e.g. HER2 is a poor prognostic feature in metastatic breast cancer

& in this CLL analysis
Having MRD is bad! (unsurprising)
#ASH23
ash.confex.com/ash/2023/webpr…
Image
Read 16 tweets
Vinay Prasad MD MPH Profile picture
Nov 22, 2023
Small cell lung cancer is a horrible diagnosis, and I feel sadness for anyone who has it

A double lung transplant for small cell lung cancer is complete nonsense. @VUMChealth is just making things up. This story is so sad bc doctors want to practice on the island of Dr Moreau
Read 4 tweets
Vinay Prasad MD MPH Profile picture
Nov 8, 2023
Just OUT! By @DavidBenjaminMD
We discuss evidence for STARTING & STOPPING cancer drugs!
What do I mean?
Currently in cancer med, we ~always start treatment at first sign of metastatic disease, and stop at progression, but....
🧵 (follow)
free link
authors.elsevier.com/a/1i2MQ7tJEDS6…
Image
... does this make sense?
The table shows trials testing early starting vs. delayed starting of systemic Rx.
For many diseases, there is no advantage to treating even widespread, asymptomatic disease
For most disease, however, there is no study at all!!
We truly don't know Image
But generally we assume. In many tumor types, we treat even asx or mildly symptomatic metastatic diseases (denovo or recurrent)

Now, lets consider the flip side of the coin. When should we stop treatment....
Read 10 tweets

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