A single bad trial design may have cost ~$30B — where translational AI could help

hardimanjames · x · 2026-09-25

An argument for translational AI in drug development, using the PD1 race as a counterfactual: BMS's Opdivo targeted a broader population (>5% PDL1 expression) while Merck's Keytruda was more selective (>50%). Merck's head-to-head readout dominated (OS hazard ratio 0.6 vs 1.02), making Keytruda a $30B drug while Opdivo trailed at $10B.

The author estimates the NPV lost from that single poor trial-design decision could be on the order of $30B — exactly the kind of upfront decision strong translational AI could help with.

Related event: A Flawed Trial Design Cost $30 Billion — Could AI Have Prevented It?(2 posts)→

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