Steady-state, sure, you can treat 25% more.
It's $3k a patient. The five days difference in hospital stay that was implied costs a lot more than that, even if there is no mortality/morbidity benefit, and that's ignoring that we were worried about running out of hospital capacity.
In case of COVID, it's not just a cost issue, but also clearing the bed as soon as possible, to put a new patient in.
10% less hospital stay, means 10% more patients able to get help.
> ... and that's ignoring that we were worried about running out of hospital capacity.
Anyways--
> 10% less hospital stay, means 10% more patients able to get help.
This isn't true. It's only true at steady state, but if there's an exponential process you get a smaller benefit. (E.g. take the ridiculous case that 100% of patients show up on one day-- obviously a shorter stay doesn't improve the number you treat in that case).
It's just worth noting that you get significantly less than a 1/.9 benefit in capacity when you shorten hospitalization times by 10%. It's a benefit, but it's only this ideal value when things are perfectly steady state. So sorry for the pedantry, but "10% less hospital stay, means 10% more patients able to get help."--- it's not the predicted 11% or even 10%.
Secondary endpoints, decisions about when to end trials, etc, are all fraught with peril.
It's worth noting that neither SIMPLE nor the ACTT-1 Remdesivir studies moved from a mortality to a non-mortality endpoint. SIMPLE did have an endpoint change before any data was available, but it was a relatively minor, innocuous thing.
> The primary efficacy end point was clinical status assessed on day 14 on a 7-point ordinal scale consisting of the following categories: 1, death; 2, hospitalized, receiving invasive mechanical ventilation or ECMO; 3, hospitalized, receiving noninvasive ventilation or high-flow oxygen devices; 4, hospitalized, requiring low-flow supplemental oxygen; 5, hospitalized, not requiring supplemental oxygen but receiving ongoing medical care (related or not related to Covid-19); 6, hospitalized, requiring neither supplemental oxygen nor ongoing medical care (other than that specified in the protocol for remdesivir administration); and 7, not hospitalized (see Table S1 in the Supplementary Appendix, available at NEJM.org).
Of course it's disappointing to see it may not be as effective as we previously thought. And of course analysis may yet reveal issues with either one or the other or both studies. That's how science works - facts, not heartfelt desires.
Perhaps we are talking about different things? I was addressing the current COVID-19 pandemic.
I don't think the science is solid when a trial can pick from 2nd-tier endpoints and stop the trial once an improvement is found. It is quite possible that if the trial had gone on longer the one positive effect would be reduced or even go away entirely or that we would see a negative effect in a more important endpoint.