ECONOMICS AND PRECISION MEDICINE

Question 1

PRECISION MEDICINE?

Answer 1

AN APPROACH FOR DISEASE TRETAMENT AND PREVENTION THAT TAKES INTO ACCOUNT INDIVIDUAL VARIABILITY IN GENES, ENVIRONMENT, AND LIFESTYLE FOR EACH PERSON

• IT ALLOWS MORE ACCURATE PREDICITION ABOUT THE TREATMENT AND PREVENTION STARTEGIES FOR A PARTICULAR DISEASE FOR PARTICULAR GROUPS OF PEOPLE
• EMERGING NOVEL HEALTH TECHNOLOGY IN CONTRAST OF TRADITIONAL ‘ONE-SIZE-FITS ALL’ APPROACH

Question 2

ADVANTAGES OF PRECISION MEDICINE

Answer 2

• WIDER ABILITY OF DOCTORS TO USE PATIENTS’ GENETIC AND OTHER MOLECULAR INFO AS PART OF ROUTINE MEDICAL CARE
• IMPROVED ABILITY TO PREDICT WHICH TREATMENTS WILL WORK BEST FOR SPECIFIC PATIENTS
• BETTER UNDERSTANDING OF THE UNDERLYING MECHANISMS BY WHICH VARIOUS DISEASES OCCUR
• IMPROVED APPROACHES TO PREVENTING, DIAGNOSING, AND TREATING A WIDE RANGE OF DISEASES
• BETTER INTEGRATION OF ELECTRONIC HEALTH RECORDS (EHRs) IN PATIENT CARE, WHICH WILL ALLOW DOCTORS AND RESEARCHES TO ACCESS MEDICAL DATA MORE EASILY

Question 3

COMMERCIAL CHALLENGES OF PRECISION MEDICINE

Answer 3

• UNLIKE TRADITIONAL MEDICINE, WHERE MANUFACTURERS CAN EARN MORE SELLING PRODUCTS TO A LARGE POPULATION, PRECISION MEDICINES DO NOT PROVIDE SUCH OPPORTUNITY
• CHALLENGE VERY SIMILAR TO THE ONES POSED BY ORPHAN MEDICINES, WHERE MANUFACTURERS OFTEN CHARGE LARGE AMOUNT OF MONEY FOR THEIR PRODUCTS
• THIS CHALLENGE MAY HAVE DIFFERENT IMPLICATIONS IN THE TECHNOLOGY ASSESSMENT OF PRECISION MEDICINE, ESPECIALLY FOR THE ECONOMIC EVALUATION

Question 4

OPPORTUNITY COST IN HEALTHCARE

Answer 4

EXPRESSED IN TERMS OF HEALTH FORGONE, THE RESOURCES THAT COULD HAVE BEEN USED IN THEIR NEXT BEST ALTERNATIVE USE

Question 5

ECONOMIC EVALUATION DEFINITION + APPLICATION TO HEALTHCARE

Answer 5

A COMPARATIVE ANALYSIS OF ALTERNATIVE COURSES OF ACTION IN TERMS OF BOTH THEIR COSTS AND CONSEQUENCES

• USEFUL BECAUSE IT WEIGHS UP BOTH THE COST AND HEALTH OUTCOOMES FROM ALTERNATIVE TECHNOLOGIES
• HEALTH OUTCOMES IN THE UK OFTEN EXPRESSED AS QALYs, BUT THAT’S NOT THE ONLY POSSIBLE WAY
• JUDGEMENTS ABOUT RELATIVE COST-EFFECTIVENESS CAN THEN BE MADE BY EXAMINING THE DIFFERENCES IN COSTS AND HEALTH OUTCOMES AGAINST A HEALTH SYSTEM’S COST-EFFECTIVENESS TRESHOLD

Question 6

COST-EFFECTIVENESS PLANE

Answer 6

The cost-effectiveness plane is used to visually represent the differences in costs and health outcomes between treatment alternatives in two dimensions, by plotting the costs against effects on a graph. Health outcomes (effects) are usually plotted on the x axis and costs on the y axis.

INCREMENTAL COST - DIFFERENCE IN PRICE
INCREMENTAL EFFECTIVENSS - DIFFERENCE IN QALYs

QUADRANTS:
A: MORE EXPENSIVE, MORE EFFECTIVE
B: MORE EXPENSIVE, LESS EFFECTIVE
C: LESS EXPENSIVE, LESS EFFECTIVE
D: LESS EXPENSIVE, MORE EFFECTIVE

TRESHOLD LINE - INDICATES THE AMOUNT OF COMPROMISE THE RELEVANT STAKEHOLDER IS WILLING TO MAKE (E.G. MAX PRICE, MIN EFFECTIVENESS)

Question 7

WILLINGNESS TO PAY TRESHOLD IN THE UK

Answer 7

20 000 PUNDS PER QALY (TO 30K)

Question 8

COMPARATORS IN ECONOMIC EVALUATION OF NEW HEALTHCARE TECHNOLOGIES

Answer 8

• LOGICAL TO CONSIDER THAT CURRENT CARE IS THE COMPARATOR
• BUT THERE MIGHT BE A NUMBER OF TESTS AND DIFFERENT STRATEGIES, NOT ALWAYS STREAMLINED/STRAIGHTFORWARD
• BETS TO SEEK EXPERT OPINION ABOUT WHAT IS CURRENTLY IN USE AND WHAT MIGHT BE USED INSTEAD TO GET A LIST OF VIABLE COMPARATORS AND NARROW IT DOWN
• CAN THERE COMPARE MULTIPLE STRATEGIES AGAINST A SINGLE COMPARATOR

Question 9

EXAMPLES OF HEALTH OUTCOMES CONSIDERED IN ECONOMIC EVALUATIONS OF CANCER TREATMENT

Answer 9

• LIFE EXPECTANCY
• PROGRESSION-FREE SURVIVAL
  (BOTH MIGHT MISS OUT ON HOW THE PATIENT IS FEELING)
• QALYs (COMBINE LENGTH OF LIFE AND QUALITY OF LIFE!!! & ARE COMPARABLE ACROSS DIFFERENT CONDITIONS!!!!)

Question 10

WHEN DOING EE IN HEALTHCARE, WHAT SHOULD BE CONSIDERED AS COSTS?

Answer 10

• CONSDIER ALL RELEVANT RESOURCES
• MEASURE THE UNITS USED
• IDENTIFY THE COST TO THE HEALTH SYSTEM ON A PER UNIT BASIS!!!!!!!!!!!!!!!!
• STAFF TIME (HOURS) BASED ON GRADE OF STAFF WORKER
• ALL TESTS AND PROCEDURES
• INITIAL AND FOLLOW UP TESTS AND PROCEDURES (E.G. SPECIALIST LAB PROCESSING COSTS)

Question 11

ROLE OF ECONOMIC EVALUATIONS IN USING PRECISION MEDICINE WHEN HETEROGENEITY IS OBSERVED IN A CONDITION AND CONSEQUENCES ARE DEPENDENT ON PATIENT CHARACTERISTICS?

Answer 11

CAN PROVIDE JUDGEMENTS AS TO WHICH SUB-GROUP OF PATIENTS WILL BENEFIT FROM A CERTAIN TECHNOLOGY

Question 12

OTHER NAME FOR PRECISION MEDICINE

Answer 12

PERSONALISED MEDICINE

Question 13

QRISK?

Answer 13

• RISK PREDICTION TOOL
• Adults aged 40 to 74 who attend an NHS Health Check should have their cardiovascular
  disease risk score calculated using the QRISK calculator - COMMONLY USED IN GENERAL PRACTICE
• PRESCRIBING SUPPORT TOOL, HELPS IDENTIFY THE POTNETIAL FOR TREATMENT WITH STATINS
• EXAMPLE OF PRECISION/PERSONALISED MEDICINE

Question 14

EXAMPLES OF HOW APPS CANE BE USED IN PRECISION MEDICINE

Answer 14

SMART APPS THAT ANALYSE SOCIAL OR LIFESTYLE DETERMINANTS. E.G. MyHeartCounts

SKIN CANCER MELANOMA DETECTON APP - SkinVision

Question 15

STEPHEN SENN - CONCERNS ABOUT PERSONALISED MEDICINE

Answer 15

• MISLEADING TERMINOLOGY
• FALSE HOPE ABOUT POTNETIAL TAILORING OF DRUGS TO INDIVIDUALS

‘WHAT I TAKE ISSUE WITH IS THE DE FACTO ASSUMPTION - OFTEN MADE IN STUDIES OF CHRONIC DISEASES SUCH AS MIGRAINE AND ASTHMA - THAT THE DIFFERENTIAL RESPONSE TO A DRUG IS CONSISTENT FOR EACH INDIVIDUAL, PREDICTABLE AND BASED ON OME STABLE PROPERTY, SUCH AS A YET-TO-BE-DISCOVERED GENETIC VARIANT’

Question 16

CHALLENGES IN ECONOMIC EVALUATION OF PERSONALISED MEDICINE

Answer 16

• LACK OF DATA WITH ALTERNATIVES
• UNCERTAINTY (ECONOMIC MODELLING)
• COSTING METHODOLY
• CONSTRAINTS AND CAPACITY WITHIN THE NHS
• MORE APPRAISALS AND THE NEED FOR BESPOKE GUIDANCE
• DRAMATIC PACE OF TECHNOLOGICAL INNOVATION
• EQUITY/ETHICAL CONCERNS