Selection bias, investment decisions and treatment effect distributions

Pharm Stat. 2021 Nov;20(6):1168-1182. doi: 10.1002/pst.2132. Epub 2021 May 17.

Abstract

When making decisions regarding the investment and design for a Phase 3 programme in the development of a new drug, the results from preceding Phase 2 trials are an important source of information. However, only projects in which the Phase 2 results show promising treatment effects will typically be considered for a Phase 3 investment decision. This implies that, for those projects where Phase 3 is pursued, the underlying Phase 2 estimates are subject to selection bias. We will in this article investigate the nature of this selection bias based on a selection of distributions for the treatment effect. We illustrate some properties of Bayesian estimates, providing shrinkage of the Phase 2 estimate to counteract the selection bias. We further give some empirical guidance regarding the choice of prior distribution and comment on the consequences for decision-making in investment and planning for Phase 3 programmes.

Keywords: COVID-19; Go/No Go decision; clinical development; efficacy prior; regression to the mean.

MeSH terms

  • Bayes Theorem*
  • Bias
  • Humans
  • Selection Bias