[vibrio]

To add a somewhat cynical view, a significant part of the original motivation for the ranibizumab (Lucentis) development was due to pricing arbitrage across diseases. bevicizumab was priced based on uses in cancer indications with a “large” volume (many mls) used for systemic infusion. The same product injected into the eye, in say a 1:1000 volume, could be efficacious for AMD, but pricing per volume would be trivial amount at the bevi cost per volume. So they tweaked the active ingredient to a new product (exact same mechanism ) and raised the price per volume to a market standard cost per treatment. There may be some pk-type benefits to the derivative , but the pricing context is an industry case study.

[s1artibartfast]

Yeah, I think that's especially relevant here too and reinforces the phenomenon where US hcps will opt for the best independent of price, even if the marginal benefit is vanishingly small or hypothetical/not data driven.

Some providers did opt to self-compound avastin for off label use mostly in Europe but also in the US.

The idea that Pharma companies would pass on developing a product 1% better than keytruda, or that hcps would pass on buying is laughable