Valuations as Mediators Between Science and the Market: How Economic Assumptions Shape Pharmaceutical Trial Designs

Abstract

How can economic assumptions be present in the heart of commercially driven drug development research? Such assumptions underpin industry-based bio-statistical discussions around a new pharmaceutical trial design, the ‘compound finder’. This example illustrates several ways in which trials might be designed and situated in the larger setting of interlinked valuation practices central to the development, distribution, and use of pharmaceuticals. It shows how economic assumptions and considerations can be differently entwined with endeavors to produce knowledge. Different trial designs may further differ in what knowledge they produce. Adaptive design trials (ADTs), of which the compound finder is one kind, share the feature that they might be the object of thousands of simulations to specify the design taking many different kinds of considerations into account. These considerations include several economic aspects such as trial costs and assumptions about the future market. ADTs will likely continue to become more common in the years to come, even if the future for the specific compound finder trial design is uncertain. Yet, the continued rise in importance of ADTs means a further intimate entwining of economic assumptions into the specification of trial designs. This will be consequential for what knowledge is produced as well as where and how treatments are assessed.