WRT Repatha trials:
If the trial is huge for efficacy reasons, it is likely that the Number Needed to Treat (NNT), even for Relative Risk Reduction (RRR), is poor. And for Absolute Risk Reduction (ARR) it is even lower. This is the general flavor of the post you linked to - and it isn't wrong, but I would suggest it isn't exactly right either.
The repatha trials are just a continuation of Big Pharma's attempt to get the maximum patient population - i.e. the one that just finished was a fairly indiscriminate, almost all comers, trial (I doubt there are too many secondary patients that didn't meet the enrollment criteria under existing SOC).
But the risk is not flat across the population - there are at least 3 or 4 biomarkers that probably indicate much larger risk. E.g. High Apo(a), ... .
So there is still substantial possibility to get much better NNTs in cardiology - we just need to have very clear ideas of risk biomarkers, and targets other than LDL. The problem is that there needs to be an incentive to target them - but in a universe where there are no limits to $ spent to treat one person in a population, it makes sense to target the biggest possible population by including as many nonsensical patients as possible.
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