The art of the trade-off: How to prioritise indications when every path matters

When I think about indication prioritization, I often picture a set of crossroads with signposts pointing in every direction. Each path looks viable, each has its risks, and the clock is ticking on which one you choose. For early-stage biotechs, that choice can feel existential. Pick the wrong road and you risk years of effort with little to show for it. Pick the right one and you set the stage for approval, adoption, and meaningful impact for patients.

What makes this choice so difficult is that every path does matter. Each indication will have patients in need, scientific rationale, and potential value. The real art is in weighing those opportunities against one another, and making decisions that balance scientific ambition with commercial viability.

Why indication prioritization is so hard

On paper, the criteria are clear: prevalence, unmet need, competitive intensity, pricing potential, and market readiness. In practice, the data are often incomplete or fragmented. Prevalence might be poorly documented in certain geographies, or competitive pipelines may be moving faster than published literature reflects. Patient and clinician sentiment can shift rapidly, especially in therapy areas where digital dialogue is active.

It is tempting to default to intuition in the face of uncertainty. But in my experience, intuition is only useful when grounded in the best available evidence. The real challenge is not whether to make trade-offs, but how to make them with conviction.

A client example

We recently worked with a biotech company facing this exact dilemma. They had multiple potential launch indications, each with promise, but their dataset looked like a half-finished puzzle. Pieces of prevalence data here, fragments of competitor intelligence there, but nothing that gave them a clear picture of which path would position them best for success.

Our approach was to bridge the gaps systematically. We began by reviewing the literature to establish disease prevalence, then layered on forecasting models that looked ahead at future burden. We refined this view by geography and demographics to reflect the reality of who might benefit and where.

From there, we assessed competitor pipelines and pricing benchmarks, building a picture of the competitive pressure and potential value story in each indication. Our digital intelligence team added a final layer, capturing how patients and clinicians were discussing these conditions online, and how competitors were being perceived in those conversations.

The result was a set of tailored intelligence boards that allowed the client to explore scenarios visually, weigh trade-offs transparently, and pressure-test assumptions against evidence.

What the process delivered

For the client, this was not just a knowledge exercise. It was a shift from uncertainty to clarity. They moved from fragmented datasets to a structured, evidence-led framework that supported real decision-making. More importantly, the process aligned stakeholders internally. With the trade-offs clearly articulated, the team could agree on a path forward with confidence rather than debate.

We did not tell them which path to take. Instead, we gave them the tools to see each road in context, and the confidence to choose the one that balanced prevalence, unmet need, pricing potential, and readiness.

A broader lesson for portfolio leaders

The lesson here is that indication prioritization is never about finding the single perfect answer. It is about recognizing that every path matters, then using structured evidence to decide which one matters most at a given moment in time.

At VISFO, we see this as part of our role: to help brilliant teams in pharma and biotech make tough choices faster, with confidence. By combining data-driven insight with tools that make trade-offs explicit, we turn complexity into structured options that teams can rally behind.

Because at the end of the day, success in portfolio strategy is not about avoiding trade-offs. It is about mastering them.