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Health insurers and national health systems have every reason to find out whether half the dose or half the duration of a costly drug works as well. They would fund those trials directly and keep the savings.
Payers commission pragmatic randomised trials of dose reduction, shorter duration, extended dosing intervals, stopping rules and cheaper alternatives for high-cost oncology drugs, embedded in routine care with registry endpoints. No manufacturer will run these; academic groups lack money. Precedents include the UK's REFINE-Lung (reduced-frequency pembrolizumab), the Netherlands' payer-supported trials of lower-dose abiraterone and dose-reduced ibrutinib, and the Dutch SONIA trial on CDK4/6 sequencing, whose savings dwarfed its cost. A standing payer trials fund with a savings-reinvestment rule would make this systematic.
Shares Wrong doses, Incentives reward me-too drugs and marginal gains, Prices and value, Pembrolizumab.
Shares Wrong doses, Incentives reward me-too drugs and marginal gains, Prices and value, Pembrolizumab.
Shares A trials fund reserved for older and multimorbid patients, A fixed share of trial-group funding for getting proven care to patients.
Shares Wrong doses, Prices and value, Pembrolizumab.
Shares Wrong doses, Prices and value, Pembrolizumab.
Shares Wrong doses, Prices and value.
Shares Wrong doses, Prices and value, Pembrolizumab.
Shares Ribociclib, Palbociclib.
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