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).
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.