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Background The statistical significance of clinical trial outcomes is generally interpreted quantitatively according to the same threshold of 2.5% (in one-sided tests) to control the false-positive rate or type I error, regardless of the burden of disease or patient preferences. The clinical significance of trial outcomes—including patient preferences—are also considered, but through qualitative means that may be challenging to reconcile with the statistical evidence. Objective We aimed to apply Bayesian decision analysis to heart failure device studies to choose an optimal significance threshold that maximizes the expected utility to patients across both the null and alternative hypotheses, thereby allowing clinical significance to be incorporated into statistical decisions either in the trial design stage or in the post-trial interpretation stage. In this context, utility is a measure of how much well-being the approval decision for the treatment provides to the patient. Methods We use the results from a discrete-choice experiment study focusing on heart failure patients’ preferences, questioning respondents about their willingness to accept therapeutic risks in exchange for quantifiable benefits with alternative hypothetical medical device performance characteristics. These benefit–risk trade-off data allow us to estimate the loss in utility—from the patient perspective—of a false-positive or false-negative pivotal trial result. We compute the Bayesian decision analysis-optimal statistical significance threshold that maximizes the expected utility to heart failure patients for a hypothetical two-arm, fixed-sample, randomized controlled trial. An interactive Excel-based tool is provided that illustrates how the optimal statistical significance threshold changes as a function of patients’ preferences for varying rates of false positives and false negatives, and as a function of assumed key parameters. Results In our baseline analysis, the Bayesian decision

Background We consider two key challenges that early-stage biotechnology firms face in developing a sustainable financing strategy and a sustainable business model: developing a valuation model for drug compounds, and choosing an appropriate operating model and corporate structure. We use the specific example of Unravel Biosciences—a therapeutics platform company that identifies novel drug targets through off-target mechanisms of existing drugs and then develops optimized new molecules—throughout the paper and explore a specific scenario of drug repurposing for rare genetic diseases. Results The first challenge consists of producing a realistic financial valuation of a potential rare disease repurposed drug compound, in this case targeting Rett syndrome. More generally, we develop a framework to value a portfolio of pairwise correlated rare disease compounds in early-stage development and quantify its risk profile. We estimate the probability of a negative return to be $$80.8\%$$ 80.8 % for a single compound and $$56.1\%$$ 56.1 % for a portfolio of 8 drugs. The probability of selling the project at a loss decreases from $$79.2\%$$ 79.2 % (phase 3) for a single compound to $$55.4\%$$ 55.4 % (phase 3) for the 8-drug portfolio. For the second challenge, we find that the choice of operating model and corporate structure is crucial for early-stage biotech startups and illustrate this point with three concrete examples. Conclusions Repurposing existing compounds offers important advantages that could help early-stage biotech startups better align their business and financing issues with their scientific and medical objectives, enter a space that is not occupied by large pharmaceutical companies, and accelerate the validation of their drug development platform.

Following the approval by the FDA of two COVID-19 vaccines, which are administered in two doses three to four weeks apart, we simulate the effects of various vaccine distribution policies on the cumulative number of infections and deaths in the United States in the presence of shocks to the supply of vaccines. Our forecasts suggest that allocating more than 50% of available doses to individuals who have not received their first dose can significantly increase the number of lives saved and significantly reduce the number of COVID-19 infections. We find that a 50% allocation saves on average 33% more lives, and prevents on average 32% more infections relative to a policy that guarantees a second dose within the recommended time frame to all individuals who have already received their first dose. In fact, in the presence of supply shocks, we find that the former policy would save on average 8, 793 lives and prevents on average 607, 100 infections while the latter policy would save on average 6, 609 lives and prevents on average 460, 743 infections.

Thesis: S.M., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2016., Cataloged from PDF version of thesis., Includes bibliographical references (pages 131-132)., The problem of maximizing the spread of an opinion inside a social network has been investigated extensively during the past decade. The importance of this problem in applications such as marketing has been amplified by the major expansion of online social networks. In this thesis, we study opinion control policies, first under a broad class of deterministic dynamics governing the interactions inside a network, and then under the classical "Voter Model". In the former case, we design a policy that a controller can follow in order to spread an opinion inside a network with the smallest possible cost. In the latter case, we consider networks whose underlying graph is the d-dimensional integer torus Zd/n, and we design policies that minimize the expected time until the network reaches a consensus. We also show that, in dimension d >/= 2, dynamic policies do not perform significantly better than static policies, while, in dimension d = 1, optimal dynamic policies perform much better than optimal static policies.., by Zied Ben Chaouch., S.M.