It seems reasonable to revisit this post from about a year ago… In it, I posed the question: how much is decision making worth?
The answer, with 2022 numbers in hand, looks like about $75bn - the difference between 1st and 5th in what is, at the molecule level, a me-too market.
Let’s be clear. Whatever differences you think exist between the PD-1s and PD-L1s, these were not ‘known’ in the 2000s, or even 10 years ago. What was happening in at least two companies was, however, very different than in the three other ‘oncology’ companies. This was not a decision making landscape of perfect knowledge. Analysts projections at the time only accorded ‘order of entry’ differences between them - those aren’t necessarily proven wrong by what happened, but the magnitude of that difference has surprised many. Of course, the decision to be 4th to market is still a decision, whether it was made passively or actively. The key question should be ‘which market?’
The decision to develop, and how to develop, and where to develop, happened very differently in these five companies, and for different reasons. All of these things - context, rationale, strategy, capacity, capability and more - contribute to both early- and late-stage decision-making. The companies that did best here didn’t ‘know more’ than the other companies, but they did learn better. That includes understanding what they were seeing in early phase, as well as whether or not they knew where the drugs might work.
If there is a great ‘sliding doors’ moment for this class, it is ‘what would have happened if BMS had maintained its lead?’ There is little doubt from the numbers that BMS got their first launch ‘right’ compared to Keytruda. That they lost it is also clear. The question about ‘why’ will yield different answers, depending on who you listen to. One answer suggests that winning early didn’t help their subsequent strategy - they went into ‘defend the lead’ mode, inadvertently, or on purpose. However, Keytruda’s decision to study broadly became its strength - built on a ‘because we can’t know where it works, let’s go looking’ approach.
So, the answer to the question: how much does decision making matter in pharmaceuticals?, the answer in 2023 is $75bn. This time next year? $100bn or more.
