Do you think Virta came up with their product out of thin air? A random stroke of luck? Do you think their published results demonstrating efficacy are fabricated or have no meaning?
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No, I was being glib about the fact that they appeared to have had very significant funding and yet ran a study that had several fairly major weaknesses (I.e. unrandomized) when it would've been just as easy to do it right
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Ah! Glib gets me every time. Clearly they achieved results needed to excite investors but didn't create a study that was going to create a complete paradigm shift in standard of care/guidelines, although suspect they have definitely 'moved the needle.'
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I don't think they have, at least where I work. Everyone looked at it and said it was a marketing stunt or something similar. People were much more impressed with DIREcT
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I can see how researchers are excited by DiRECT based on trial design where as physicians working with patients are excited by virta’s results.
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Actually, not so much. None of the clinicians I know has so far been impressed with Virta, particularly after seeing the ~$6,000 AUD per year price tag
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If finance is concern then you need to run the numbers. What is the cost savings of insulin reduction/elimination, other medications, and then estimate decrease in T2d complications based on lowering a1c, ldl-p, bp, crp, etc. etc Suspect $6000 is very cost effective.
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But we have no way of knowing if it's cost-effective. For that, we'd have to have an RCT comparing Virta to at least normal care (or ideally best-practice care), and create an incremental cost-effectiveness ratio. That's kind of the problem with running a flawed trial!
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Do you think virta’s cost saving estimates per patient are out of keeping with reality? It would be neat to see Virta type IT platforms serve as a delivery system of different well designed dietary interventions for RCT purposes. Lot of $$ would be needed to develop resources.
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I'm not saying they're out of keeping with reality, but I would say that they are, similarly to the study, misleading, because it's a case of comparing Virta to another effective treatment, not care as usual/nothing
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For example, we are currently applying for grant funding to run a trial similar to DiRECT, and our cost per patient/year including supplying all meal replacement and drugs comes out somewhere between 1/4 and 1/3 of the cost of Virta including study costs
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The current Virta economics are basically comparing Virta with their control - no treatment What would they look like if they were compared to another, cheaper, intensive lifestyle control program? There's one at the hospital I work at that's run at a fraction of the cost
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But all of this comes back to a really rigorous RCT! If we had such results, and cost data, we could know exactly how effective Virta is compared to the next best treatment Alas, we don't have this information, which is a big issue
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