Economics of precision medicine: beyond the single test-treat strategy

Abstract: Precision medicine (also referred to as personalised or stratified medicine) is criticised for not delivering on its promise to benefit patient populations by improving health. There are, however, expanding examples of application in clinical practice. The emergence of precision medicine is underpinned by developing knowledge of biological phenomena at the ‘omics’ level (genomics, epigenomics, transcriptomics proteomics, metabolomics); but the informed use of precision medicine requires economics. Examples of precision medicine are now moving beyond using a single test-treat strategy to inform management options by combining ‘omics’ data with information about shared identifiable characteristics within sub-groups of patient populations. The aim of this presentation is to describe the implications of this developing paradigm of precision medicine with a focus on generating economic evidence to inform resource allocation decisions. The presentation will draw on specific examples of precision medicine, using: a risk prediction algorithm and/or breast density to inform a stratified breast screening programme; an antidrug antibody and drug level test to target the use of biologic therapies in rheumatoid arthritis; a predictive algorithm to predict response to methotrexate in rheumatoid arthritis; multiple biomarker tests to predict response to targeted treatments in lung cancer. Specific elements for each decision problem that will be described and discussed include: precision medicine as a complex intervention; selecting the relevant intervention when multiple strategies are feasible; what is the relevant comparator; how to identify the unit cost of the strategy to stratify; moving beyond the research context and the assumption of infinite capacity.