Evaluating new product decision processes

The development of a new product is often a sequential-decision process with many available stages at which the product may take any one of a number of alternate courses of action. This paper identifies an efficient algorithm for solving this sequential-decision process. A computer program, involving the algorithm, has been written to solve problems containing up to one thousand stages. Input into the program includes the subjective probabilities of success for each decision branch, the cost associated with each decision stage and level, the rate for discounting all monetary values to the present plus an indicator for each decision stage and level of the desired decision criterion. The algorithm utilizes the dynamic-programming solution approach. The output of the algorithm contains the minimum, or maximum, expected discounted decision values for each stage and level of the network. The algorithm and computer program have been primarily utilized in the pharmaceutical industry. An illustrative, exemplary use of the algorithm in this industry is presented.

Aortic Valve Surgery in Nonelderly Patients: Insights Gained From AVIATOR

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally – this is the vision of the AVIATOR registry and our common responsibility