Ann: Head-to-head IIT with SAR-bisPSMA, page-153

Head-to-Head Testing: What Happens to the 2nd and 3rd Best Options?

ANS: They don’t have to disappear!

The Head-to-Head Clinical Trial is necessary, not as vindication to anyone (Alan, Louise, or some HC punters), but for patients! If the objective is to provide the best care for patients, the best must be identified!

The same way; knowing which is the "second-best" or "third-best" can be incredibly empowering, by helping patients and their doctors set realistic expectations and make informed decisions about next steps.

Its important to realise that a negative result on a cancer diagnostic test doesn’t mean that the patient is cancer-free. Instead, a negative result is used in recalculating the estimated risk of having that condition (the cancer). This adjusted risk, which is a post-test probability, can be used to then guide what actions to take next.

A negative test result tells the doctor that the calculated personal risk that this patient has had a cancer recurrence is lower than what the doctor previously thought before doing the test. It is the magnitude of that lowering (the discount) that is directly linked to how good the test is (using Likelihood Ratios).

So, if the negative result comes from the best test, you get the best reduction to the calculated personal probability that you have a cancer recurrence (it gives the largest discount - like the large discounts that sophs and instos get when our companies do their raises. A negative from the 2nd and 3rd best will reduce the probabilities too, but the reduction will not be as large as the one from the Best in Class (BIC).

Further action: A person who ends up with <2% chance of cancer, will act differently from one who is at 15%! While a <2% might go home happy, the 15% might ask for another PSA, another scan, or even, another shot of radiation therapy.

In the end, they may all remain, and other matters may then determine how they get used. BIC usually charges more, while the others tend to be cheaper.

I am invested in Clarity for the Superior Science!
I am invested in Telix for the business execution: A generic that anyone can use, is raking in billions!
I am invested in Lantheus for the opportunity: I think the recent sell off was overdone!