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Winchester LM, Harshfield EL, Shi L, Badhwar A, Khleifat AA, Clarke N, Dehsarvi A, Lengyel I, Lourida I, Madan CR, Marzi SJ, Proitsi P, Rajkumar AP, Rittman T, Silajdžić E, Tamburin S, Ranson JM, Llewellyn DJ. Artificial intelligence for biomarker discovery in Alzheimer's disease and dementia. Alzheimers Dement 2023; 19:5860-5871. [PMID: 37654029 PMCID: PMC10840606 DOI: 10.1002/alz.13390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 09/02/2023]
Abstract
With the increase in large multimodal cohorts and high-throughput technologies, the potential for discovering novel biomarkers is no longer limited by data set size. Artificial intelligence (AI) and machine learning approaches have been developed to detect novel biomarkers and interactions in complex data sets. We discuss exemplar uses and evaluate current applications and limitations of AI to discover novel biomarkers. Remaining challenges include a lack of diversity in the data sets available, the sheer complexity of investigating interactions, the invasiveness and cost of some biomarkers, and poor reporting in some studies. Overcoming these challenges will involve collecting data from underrepresented populations, developing more powerful AI approaches, validating the use of noninvasive biomarkers, and adhering to reporting guidelines. By harnessing rich multimodal data through AI approaches and international collaborative innovation, we are well positioned to identify clinically useful biomarkers that are accurate, generalizable, unbiased, and acceptable in clinical practice. HIGHLIGHTS: Artificial intelligence and machine learning approaches may accelerate dementia biomarker discovery. Remaining challenges include data set suitability due to size and bias in cohort selection. Multimodal data, diverse data sets, improved machine learning approaches, real-world validation, and interdisciplinary collaboration are required.
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Affiliation(s)
| | - Eric L Harshfield
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, Cambridge, UK
| | - Liu Shi
- Novo Nordisk Research Centre Oxford (NNRCO), Headington, UK
| | - AmanPreet Badhwar
- Département de Pharmacologie et Physiologie, Institut de Génie Biomédical, Faculté de Médecine, Université de Montréal, Montreal, Canada
- Centre de recherche de l'Institut Universitaire de Gériatrie (CRIUGM), Montreal, Canada
| | - Ahmad Al Khleifat
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Natasha Clarke
- Centre de recherche de l'Institut Universitaire de Gériatrie (CRIUGM), Montreal, Canada
| | - Amir Dehsarvi
- School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Imre Lengyel
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast, UK
| | - Ilianna Lourida
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | | | - Sarah J Marzi
- UK Dementia Research Institute at Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Petroula Proitsi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anto P Rajkumar
- Institute of Mental Health, Mental Health and Clinical Neurosciences academic unit, University of Nottingham, Nottingham, UK, Mental health services of older people, Nottinghamshire healthcare NHS foundation trust, Nottingham, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Edina Silajdžić
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Janice M Ranson
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - David J Llewellyn
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
- The Alan Turing Institute, London, UK
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Liu S, Tan DS, Graves N, Chacko AM. Economic Evaluations of Imaging Biomarker-Driven Companion Diagnostics for Cancer: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:841-855. [PMID: 37747620 DOI: 10.1007/s40258-023-00833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION There is a boom in imaging biomarker-driven companion and complementary diagnostics (CDx) for cancer, which brings opportunity for personalized medicine. Whether adoption of these technologies is likely to be cost-effective is a relevant question, and studies on this topic are emerging. Despite the growing number of economic evaluations, no review of the methods used, quality of reporting, and potential risk of bias has been done. We report a systematic review to identify, summarize, and critique the cost-effectiveness evidence for the use of biomarker-driven and imaging-based CDx to inform cancer treatments. METHODS The Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Systematic literature searches until 30 December 2022 were performed in PubMed, Web of Science, Medline, Embase, and Scopus for economic evaluations of imaging biomarker-based CDx for cancer. The inclusion and exclusion of studies were determined by pre-specified eligibility criteria informed by the 'Patient, Intervention, Comparison, Outcome' (PICO) framework. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the quality of reporting, and the Bias in Economic Evaluation (ECOBIAS) was used to examine the potential risk of bias of included studies. RESULTS A total of 12 papers were included, with eight model-based and four trial-based studies. Implementing biomarker-driven, imaging-based CDx was reported to be cost-effective, cost saving, or dominant (cost saving and more effective) in ten papers. Inconsistent methods were found in the studies, and the quality of reporting was lacking against the CHEERS reporting guideline. Several potential sources of 'risk of bias' were identified. These should be acknowledged and carefully considered by researchers planning future health economic evaluations. CONCLUSION Despite favorable results towards the implementation of imaging biomarker-based CDx for cancer, there is room for improvement regarding the quantity and quality of economic evaluations, and that is expected as the awareness of current study limitations increases and more clinical data become available in the future.
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Affiliation(s)
- Sibo Liu
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Daniel Sw Tan
- Cancer Therapeutics Research Laboratory, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168853, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Ann-Marie Chacko
- Division of Cellular and Molecular Research, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168853, Singapore.
- Laboratory for Translational and Molecular Imaging, Programme in Cancer & Stem Cell Biology, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Choon-Quinones M, Zelei T, Németh B, Tóth M, Jia XY, Barnett M, Keown P, Durie B, Harousseau JL, Hose D, Kaló Z. Systematic literature review of health economic models developed for multiple myeloma to support future analyses. J Med Econ 2023; 26:110-119. [PMID: 36346000 DOI: 10.1080/13696998.2022.2144056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The goal of this study was to review the economic evaluations of health technologies in multiple myeloma (MM) and provide guidance and recommendations for future health economic analyses. MATERIALS AND METHODS A systemic literature review (SLR) was conducted on original economic assessment studies and structured review papers focusing on the studies in MM. The search was limited to English language papers published from 1 January 2000 onwards. Publications not applying any type of modelling methodology to describe disease progression and patient pathways over a specific time horizon were excluded. RESULTS A total of 2,643 publications were initially identified, of which 148 were eligible to be included in the full-text review phase. From these, 49 publications were included in the final analysis. Most published health economic analyses supported by models came from high-income countries. Evaluations from middle-income countries were rarely published. Diagnostic technologies were rarely modelled and integrated care had not been modelled. Very few models investigated MM treatments from a societal perspective and there was a relative lack of evaluations regarding minimal residual disease (MRD). LIMITATIONS Limitations of the publications included differences between trial populations and modelled populations, justification of methods, lack of confounder analyses, and small trial populations. Limitations of our study included the infeasibility of comparing MM economic evaluations due to the significant variance in modelled therapeutic lines and indications, and the relative scarcity of published economic evaluations from non-high-income countries. CONCLUSIONS As published economic models lacked many of the elements of the complex and heterogeneous patient pathways in MM and they focused on single decision problems, a thorough, open-source economic whole disease modelling framework is needed to assess the economic value of a wide range of technologies across countries with various income levels with a more detailed view on MM, by including patient-centric and societal aspects.
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Affiliation(s)
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | | | - Manna Tóth
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | - Mike Barnett
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Syreon Research Institute, Budapest, Hungary
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Brian Durie
- International Myeloma Foundation, North Hollywood, CA, USA
| | | | - Dirk Hose
- Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Chaudhari VS, Hole KC, Issa AM. Evaluating the quality of the economic evidence in colorectal cancer genomics studies. Per Med 2022; 19:361-375. [PMID: 35786999 DOI: 10.2217/pme-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The increase in the use of genome-based screening and diagnostic tests adds to the overall costs of oncologic care for colorectal cancer. This, in turn, has resulted in an increase in published economic analyses. Aim: To perform a systematic literature review of the available economic evidence evaluating the value of genomic testing for colorectal cancer and appraise the quality of the economic studies conducted to date. Methods: A systematic review of the literature for economic studies of colorectal cancer genomics from January 2006 through October 2020, and evaluation of study quality using the Quality of Health Economic Studies (QHES) instrument was conducted. The validated QHES was then applied to a final set of articles that met eligibility criteria. Results: Our search of the literature initially yielded 12,859 records. A final set of 49 articles met our inclusion criteria. The QHES score ranged from 24 to 100, with an average score of 82. Most of the studies (n = 40, 82%) scored above 75 and were considered of good quality. Conclusion: Our analysis revealed that most of the economic analyses of colorectal cancer genomic molecular diagnostics in the literature may be of good quality. There is, however, some variation in methodological rigor between the articles.
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Affiliation(s)
- Vivek S Chaudhari
- Personalized Precision Medicine & Targeted Therapeutics, Springfield, PA 19064, USA.,Health Policy, University of the Sciences, Philadelphia, PA 19104, USA
| | - Kanchan C Hole
- Personalized Precision Medicine & Targeted Therapeutics, Springfield, PA 19064, USA
| | - Amalia M Issa
- Personalized Precision Medicine & Targeted Therapeutics, Springfield, PA 19064, USA.,Health Policy, University of the Sciences, Philadelphia, PA 19104, USA.,Pharmaceutical Sciences, University of the Sciences, Philadelphia, PA 19104, USA.,Family Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada
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Economic evaluation of genomic/genetic tests: a review and future directions. Int J Technol Assess Health Care 2022; 38:e67. [DOI: 10.1017/s0266462322000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
It has been suggested that health economists need to improve their methods in order to meet the challenges of evaluating genomic/genetic tests. In this article, we set out twelve challenges identified from a rapid review of the literature and suggest solutions to the challenges identified. Two challenges were common to all economic evaluations: choice of perspective and time-horizon. Five challenges were relevant for all diagnostic technologies: complexity of analysis; range of costs; under-developed evidence base; behavioral aspects; and choice of outcome metrics. The final five challenges were pertinent for genomic tests and only these may require methodological development: heterogeneity of tests and platforms, increasing stratification, capturing personal utility; incidental findings; and spillover effects. Current methods of economic evaluation are generally able to cope with genomic/genetic tests, although a renewed focus on specific decision-makers’ needs and a willingness to move away from cost-utility analysis may be required. Certain analysts may be constrained by reference cases developed primarily for the assessment of pharmaceuticals. The combined impact of multiple challenges may require analysts to be particularly careful in setting the scope of their analysis in order to ensure that feasibility is balanced with usefulness to the decision maker. A key issue is the under-developed evidence-base and it may be necessary to rethink translation processes to ensure sufficient, relevant evidence is available to support economic evaluation and adoption of genomic/genetic tests.
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Mucherino S, Lorenzoni V, Orlando V, Triulzi I, Del Re M, Capuano A, Danesi R, Turchetti G, Menditto E. Cost-effectiveness of treatment optimisation with biomarkers for immunotherapy in solid tumours: a systematic review protocol. BMJ Open 2021; 11:e048141. [PMID: 34497081 PMCID: PMC8438832 DOI: 10.1136/bmjopen-2020-048141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs. METHODS AND ANALYSIS A systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020201549.
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Affiliation(s)
- Sara Mucherino
- Department of Pharmacy, University of Naples Federico II, CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Naples, Italy
| | | | - Valentina Orlando
- Department of Pharmacy, University of Naples Federico II, CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Naples, Italy
| | - Isotta Triulzi
- Scuola Superiore Sant'Anna, Institute of Management, Pisa, Italy
| | - Marzia Del Re
- University Hospital of Pisa, Unit of Clinical Pharmacology and Pharmacogenetics, Pisa, Italy
| | - Annalisa Capuano
- Section of Pharmacology 'L. Donatelli', University of Campania 'L. Vanvitelli', Department of Experimental Medicine, Napoli, Italy
| | - Romano Danesi
- University Hospital of Pisa, Unit of Clinical Pharmacology and Pharmacogenetics, Pisa, Italy
| | | | - Enrica Menditto
- Department of Pharmacy, University of Naples Federico II, CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Naples, Italy
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Seo MK, Cairns J. How are we evaluating the cost-effectiveness of companion biomarkers for targeted cancer therapies? A systematic review. BMC Cancer 2021; 21:980. [PMID: 34470603 PMCID: PMC8408935 DOI: 10.1186/s12885-021-08725-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Despite the increasing economic assessment of biomarker-guided therapies, no clear agreement exists whether existing methods are sufficient or whether different methods might produce different cost-effectiveness results. This study aims to examine current practices of modeling companion biomarkers when assessing the cost-effectiveness of targeted cancer therapies. It investigates the current methods in modeling the characteristics of companion diagnostics based on existing economic evaluations of biomarker-guided therapies in cancer. Methods A literature search was performed using Medline, Embase, EconLit, Cochrane library for economic evaluations of biomarker-guided therapies with companion diagnostics in cancer. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were selected using pre-specified eligibility criteria based on the PICO framework. To make the included studies more comparable, we qualitatively synthesized the data under nine domains of methods where consensus was deemed lacking. Results Only four of the twenty-two studies included in this review were found to be of good quality with respect to incorporating the characteristics of companion biomarkers in economic evaluations. However, many evaluations focused on a pre-selected patient group rather than including all patients regardless of their biomarker status. Companion biomarker characteristics captured in evaluations were often limited to the cost or the accuracy of the test. Often, only the costs of biomarker testing were modelled. Clinical outcomes and health state utilities were often not included due to the limited data generated by clinical trials. Methods of economic evaluation were not applied consistently in assessments of companion cancer biomarkers for targeted therapies. It was also shown that conflicting cost-effectiveness results were likely depending on what comparator arm was chosen and what comparison structure was designed in the model. Conclusion We found no consistent approach applied in assessing the value of companion biomarker tests and including the characteristics of biomarkers in an economic evaluation of targeted oncology therapies. Currently, many economic evaluations fail to capture the full value of companion biomarkers beyond sensitivity/specificity and cost related to biomarker testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08725-4.
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Affiliation(s)
- Mikyung Kelly Seo
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway. .,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - John Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway
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D Avó Luís AB, Seo MK. Has the development of cancer biomarkers to guide treatment improved health outcomes? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:789-810. [PMID: 33783662 PMCID: PMC8214594 DOI: 10.1007/s10198-021-01290-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
During the last decade, testing the patient's biomarker status prior to the administration of corresponding co-dependent therapies has been emerging in clinical practice. These biomarker-guided therapies have promoted the promise of more personalized medicine, with the prescription of the right treatment to the right patient, while avoiding expensive ineffective drugs and adverse drug reactions. Cancer treatments have especially taken advantage of this technology. We assess how the introduction of biomarker tests guiding cancer therapy have affected the premature mortality and survival of cancer patients in Norway. Our findings suggest that, in general, cancer patients have benefited from both biomarker testing and more cancer drugs. Furthermore, we find that the total effect of biomarker testing on 3-year survival decreases as the number of drugs available increases, suggesting that the matching of patients with the appropriate treatment is better when fewer drugs are available.
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Affiliation(s)
- Ana Beatriz D Avó Luís
- Department of Economics, University of Bergen, Fosswinckelsgate 14, 5007, Bergen, Norway.
- Centre for Cancer Biomarkers (CCBIO), Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Mikyung Kelly Seo
- Centre for Cancer Biomarkers (CCBIO), Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Jülicher P, O'Kane M, Price CP, Christenson R, John AS. Health economic evaluations of medical tests: Translating laboratory information into value - A case study example. Ann Clin Biochem 2021; 59:23-36. [PMID: 33874738 DOI: 10.1177/00045632211013852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health-care providers and funders are focused on identifying value in all their services and that includes laboratories. This means that in order to gain a share of scarce resources, laboratory professionals must also understand and assess the value of tests and that includes their economic impact. This can be assessed using health economic modelling tools which, when used in conjunction with a detailed value proposition for the test, can translate laboratory information into value. While a variety of health economic assessment tools are available, this review will focus on the use of decision analytic models which essentially compare the outcomes from pathways with and without the new test, the value of which is being assessed. A step-by-step framework is provided to guide laboratory professionals through the essential steps of conducting the evaluation. Initial steps include mapping the clinical pathway, understanding the goal of the evaluation, identifying the key stakeholders and their needs and determining a suitable analytical model. Following collection of the actual data, the validity of the model must be checked, and the robustness of the outcomes tested through sensitivity analysis. The last step is to translate the findings into measures of value which can then inform appropriate decisions by the stakeholders. This review of basic health economic modelling should enable laboratory professionals to have an understanding of how modelling can be applied to tests in their own environment and help deliver their potential value.
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Affiliation(s)
- Paul Jülicher
- Health Economics and Outcomes Research, Medical Affairs, Abbott Laboratories, Wiesbaden, Germany
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, UK
- Centre for Personalised Medicine: Clinical Decision Making and Patient Safety, C-TRIC, Altnagelvin Hospital, Londonderry, UK
| | - Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Christenson
- Laboratories of Pathology, University of Maryland Medical Centre, Baltimore, MD, USA
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Thiruthaneeswaran N, Bibby BAS, Yang L, Hoskin PJ, Bristow RG, Choudhury A, West C. Lost in application: Measuring hypoxia for radiotherapy optimisation. Eur J Cancer 2021; 148:260-276. [PMID: 33756422 DOI: 10.1016/j.ejca.2021.01.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/15/2022]
Abstract
The history of radiotherapy is intertwined with research on hypoxia. There is level 1a evidence that giving hypoxia-targeting treatments with radiotherapy improves locoregional control and survival without compromising late side-effects. Despite coming in and out of vogue over decades, there is now an established role for hypoxia in driving molecular alterations promoting tumour progression and metastases. While tumour genomic complexity and immune profiling offer promise, there is a stronger evidence base for personalising radiotherapy based on hypoxia status. Despite this, there is only one phase III trial targeting hypoxia modification with full transcriptomic data available. There are no biomarkers in routine use for patients undergoing radiotherapy to aid management decisions, and a roadmap is needed to ensure consistency and provide a benchmark for progression to application. Gene expression signatures address past limitations of hypoxia biomarkers and could progress biologically optimised radiotherapy. Here, we review recent developments in generating hypoxia gene expression signatures and highlight progress addressing the challenges that must be overcome to pave the way for their clinical application.
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Affiliation(s)
- Niluja Thiruthaneeswaran
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Becky A S Bibby
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Lingjang Yang
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Peter J Hoskin
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - Robert G Bristow
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; CRUK Manchester Institute and Manchester Cancer Research Centre, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Catharine West
- Division of Cancer Sciences, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
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Giusepi I, John AS, Jülicher P. Who Conducts Health Economic Evaluations of Laboratory Tests? A Scoping Review. J Appl Lab Med 2020; 5:954-966. [DOI: 10.1093/jalm/jfaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/21/2020] [Indexed: 12/23/2022]
Abstract
AbstractBackgroundHealth economic evaluations (HEEs) are effectively used to inform decision making in healthcare. We sought to assess the level of involvement of laboratory professionals (LPs) in HEEs of laboratory tests.MethodsA systematic literature search was conducted in Medline (2013 to November 28, 2018) for original articles reporting HEEs of medical laboratory tests. Eligible studies were characterized by indication, utilization, region, setting, study design, primary outcome measures, and sponsorship. Authors were classified based on stated affiliation as clinician, scientist, public health expert, or LP.ResultsIn total, 140 HEEs were included in the study, of which 24 (17.1%) had contributions from LPs. Studies were primarily focused on infectious disease (n = 68), oncology (n = 23), and cardiovascular disease (n = 16). Cost-utility or cost-effectiveness analyses (n = 117) were the most frequent study types, with effectiveness measured mainly in terms of quality-adjusted life-years (n = 57) and detected cases (n = 41). Overall, 76% of HEEs followed a social or health system perspective, whereas 15% took a hospital viewpoint. Partial or full funding was received from public health organizations or industry in 39% and 16% of studies, respectively. The involvement of LPs was associated with test utilization, secondary care, analytic perspective, and an immediate time horizon (all P < 0.05). Quality of studies was found to be lower in HEEs coauthored by LPs.ConclusionMultidisciplinary collaboration is essential to understanding the complexity of clinical pathways. HEEs are used effectively to inform healthcare decision making. The involvement of LPs in HEEs is low. This implies that laboratory expertise is frequently not considered in decision processes.
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Affiliation(s)
- Isabella Giusepi
- Health Economics and Outcomes Research, Abbott Diagnostics, Wiesbaden, Germany
| | | | - Paul Jülicher
- Health Economics and Outcomes Research, Abbott Diagnostics, Wiesbaden, Germany
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12
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Sultana M, Sarker AR, Ali N, Akram R, Gold L. Economic evaluation of community acquired pneumonia management strategies: A systematic review of literature. PLoS One 2019; 14:e0224170. [PMID: 31648271 PMCID: PMC6812874 DOI: 10.1371/journal.pone.0224170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia. Methods A systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal. Results Nineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies. Conclusion Economic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems. PROSPERO registration no: CRD42018097174
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raisul Akram
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Kip MMA, IJzerman MJ, Henriksson M, Merlin T, Weinstein MC, Phelps CE, Kusters R, Koffijberg H. Toward Alignment in the Reporting of Economic Evaluations of Diagnostic Tests and Biomarkers: The AGREEDT Checklist. Med Decis Making 2019; 38:778-788. [PMID: 30248275 PMCID: PMC6454580 DOI: 10.1177/0272989x18797590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives. General frameworks for conducting and reporting health economic
evaluations are available but not specific enough to cover the intricacies of the
evaluation of diagnostic tests and biomarkers. Such evaluations are typically complex and
model-based because tests primarily affect health outcomes indirectly and real-world data
on health outcomes are often lacking. Moreover, not all aspects relevant to the evaluation
of a diagnostic test may be known and explicitly considered for inclusion in the
evaluation, leading to a loss of transparency and replicability. To address this
challenge, this study aims to develop a comprehensive reporting checklist.
Methods. This study consisted of 3 main steps: 1) the development of an
initial checklist based on a scoping review, 2) review and critical appraisal of the
initial checklist by 4 independent experts, and 3) development of a final checklist. Each
item from the checklist is illustrated using an example from previous research.
Results. The scoping review followed by critical review by the 4 experts
resulted in a checklist containing 44 items, which ideally should be considered for
inclusion in a model-based health economic evaluation. The extent to which these items
were included or discussed in the studies identified in the scoping review varied
substantially, with 14 items not being mentioned in ≥47 (75%) of the included studies.
Conclusions. The reporting checklist developed in this study may contribute
to improved transparency and completeness of model-based health economic evaluations of
diagnostic tests and biomarkers. Use of this checklist is therefore encouraged to enhance
the interpretation, comparability, and—indirectly—the validity of the results of such
evaluations.
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Affiliation(s)
- Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Martin Henriksson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tracy Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Milton C Weinstein
- Department of Health Policy and Management Harvard T. H. Chan School of Public Health, Boston, MA
| | - Charles E Phelps
- Departments of Economics, Political Science, and Public Health Sciences, University of Rochester, Rochester, NY
| | - Ron Kusters
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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14
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Henderson R, French D, Sullivan R, Maughan T, Clarke M, Lawler M. Molecular biomarkers and precision medicine in colorectal cancer: a systematic review of health economic analyses. Oncotarget 2019; 10:3408-3423. [PMID: 31164962 PMCID: PMC6534362 DOI: 10.18632/oncotarget.26909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/21/2019] [Indexed: 12/30/2022] Open
Abstract
An increased understanding of the biology of colorectal cancer (CRC) has fuelled identification of biomarkers with potential to drive a stratified precision medicine care approach in this common malignancy. We conducted a systematic review of health economic assessments of molecular biomarkers (MBMs) and their employment in patient stratification in CRC. Our analysis revealed scenarios where health economic analyses have been applied to evaluate the cost effectiveness of MBM-guided clinical interventions: (i) evaluation of Dihydropyrimidine dehydrogenase gene (DPYD) status to identify patients susceptible to 5-Fluouracil toxicity; (ii) determination of Uridine 5′-diphospho- glucuronosyltransferase family 1 member A1 gene (UGT1A1) polymorphism status to help guide irinotecan treatment; (iii) assessment of RAS/RAF mutational status to stratify patients for chemotherapy or Epidermal Growth Factor Receptor (EGFR) therapy and (iv) multigene expression analysis (Oncotype Dx) to identify and spare non-responders the debilitating effects of particular chemotherapy interventions. Our findings indicate that Oncotype Dx is cost-effective in high income settings within specific price points, by limiting treatment toxicity in CRC patients. DPYD status testing may also be cost effective in certain settings to avoid specific 5-FU toxicities post treatment. In contrast, current research does not support UGT1A1 polymorphism status as a cost-effective guide to irinotecan dosing, while the health economic evidence to support testing of KRAS/NRAS mutational status and chemo/EGFR therapy choice was inconclusive, despite its widespread adoption in CRC treatment management. However, we also show that there is a paucity of high-quality cost-effectiveness studies to support clinical application of precision medicine approaches in CRC.
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Affiliation(s)
- Raymond Henderson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Queen's Management School, Queen's University Belfast, Belfast, United Kingdom
| | - Declan French
- Queen's Management School, Queen's University Belfast, Belfast, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London and King's Health Partners Comprehensive Cancer Centre, London, United Kingdom
| | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
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Abstract
Precision medicine is making an impact on patients, health care delivery systems, and research participants in ways that were only imagined fifteen years ago when the human genome was first sequenced. Discovery of disease-causing and drug-response genetic variants has accelerated, while adoption into clinical medicine has lagged. We define precision medicine and the stakeholder community required to enable its integration into research and health care. We explore the intersection of data science, analytics, and precision medicine in the formation of health systems that carry out research in the context of clinical care and that optimize the tools and information used to deliver improved patient outcomes. We provide examples of real-world impact and conclude with a policy and economic agenda necessary for the adoption of this new paradigm of health care both in the United States and globally.
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Affiliation(s)
- Geoffrey S Ginsburg
- Geoffrey S. Ginsburg ( ) is director of the Duke Center for Applied Genomics and Precision Medicine, Duke University, in Durham, North Carolina
| | - Kathryn A Phillips
- Kathryn A. Phillips is a professor of health economics and health services research at the University of California San Francisco
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16
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Weymann D, Pataky R, Regier DA. Economic Evaluations of Next-Generation Precision Oncology: A Critical Review. JCO Precis Oncol 2018; 2:1-23. [DOI: 10.1200/po.17.00311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Precision oncology has the potential to improve patient health and reduce treatment costs. Yet the up-front cost of genomic testing with next-generation sequencing (NGS) technologies can be prohibitive. Our study is a structured review of economic evaluations of precision oncology informed by NGS. The aim is to characterize the availability and scope of economic evidence. Materials and Methods We searched Medline (PubMed), Embase (Ovid), and Web of Science databases for English-language full-text peer-reviewed articles published between 2000 and 2016. We focused our search on articles that estimated the benefit of precision oncology in relation to its costs. We excluded studies that did not undertake full economic evaluations or did not focus on NGS technologies. We reviewed all included studies and summarized key methodological and empirical study characteristics. Results Fifty-five economic evaluations met our inclusion criteria. The number of published studies increased steadily, from three studies between 2005 and 2007 to 26 between 2014 and 2016. Most studies evaluated multiplex panels (86%). We found testing was frequently used to predict prognosis (67%), to diagnose patients (24%), or to identify targeted therapeutic options (7%). Methods and cost effectiveness differed according to NGS technology, test strategy, and cancer type. Deterministic and probabilistic analyses were typically used to characterize parameter and decision uncertainty (91% and 75%). Conclusion Although the availability of economic evidence examining precision oncology increased over time, methods used often did not align with current guidelines. Future evaluations should undertake extensive sensitivity analysis to address all sources of uncertainty associated with rapidly changing NGS technologies. Furthermore, additional research is needed evaluating the cost effectiveness of more comprehensive next-generation technologies before implementing these on a wider scale.
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Affiliation(s)
- Deirdre Weymann
- All authors, Canadian Centre for Applied Research in Cancer Control, BC Cancer; and Dean A. Regier, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Pataky
- All authors, Canadian Centre for Applied Research in Cancer Control, BC Cancer; and Dean A. Regier, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dean A. Regier
- All authors, Canadian Centre for Applied Research in Cancer Control, BC Cancer; and Dean A. Regier, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Harty G, Jarrett J, Jofre-Bonet M. Consequences of Biomarker Analysis on the Cost-Effectiveness of Cetuximab in Combination with FOLFIRI as a First-Line Treatment of Metastatic Colorectal Cancer: Personalised Medicine at Work. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:515-525. [PMID: 29948926 PMCID: PMC6028886 DOI: 10.1007/s40258-018-0395-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Therapies may be more efficacious when targeting a patient subpopulation with specific attributes, thereby enhancing the cost-effectiveness of treatment. In the CRYSTAL study, patients with metastatic colorectal cancer (mCRC) were treated with cetuximab plus FOLFIRI or FOLFIRI alone until disease progression, unacceptable toxic effects or withdrawal of consent. OBJECTIVE To determine if stratified use of cetuximab based on genetic biomarker detection improves cost-effectiveness. METHODS We used individual patient data from CRYSTAL to compare the cost-effectiveness, cost per life-year (LY) and cost per quality-adjusted LY (QALY) gained of cetuximab plus FOLFIRI versus FOLFIRI alone in three cohorts of patients with mCRC: all randomised patients (intent-to-treat; ITT), tumours with no detectable mutations in codons 12 and 13 of exon 2 of the KRAS protein ('KRAS wt') and no detectable mutations in exons 2, 3 and 4 of KRAS and exons 2, 3 and 4 of NRAS ('RAS wt'). Survival analysis was conducted using RStudio, and a cost-utility model was modified to allow comparison of the three cohorts. RESULTS The deterministic base-case ICER (cost per QALY gained) was £130,929 in the ITT, £72,053 in the KRAS wt and £44,185 in the RAS wt cohorts for cetuximab plus FOLFIRI compared with FOLFIRI alone. At a £50,000 willingness-to-pay threshold, cetuximab plus FOLFIRI has a 2.8, 20 and 63% probability of being cost-effective for the ITT, KRAS wt and RAS wt cohorts, respectively, versus FOLFIRI alone. CONCLUSION Screening for mutations in both KRAS and NRAS may provide the most cost-effective approach to patient selection.
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Affiliation(s)
- Gerard Harty
- Merck Serono Ltd, Bedfont Cross, Stanwell Road, Feltham, Middlesex, TW14 8NX, UK
| | - James Jarrett
- Mapi Group, Ltd, 73 Collier Street, London, N1 9BE, UK
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18
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Yuen T, Carter MT, Szatmari P, Ungar WJ. Cost-effectiveness of Genome and Exome Sequencing in Children Diagnosed with Autism Spectrum Disorder. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:481-493. [PMID: 29651777 DOI: 10.1007/s40258-018-0390-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Genome (GS) and exome sequencing (ES) could potentially identify pathogenic variants with greater sensitivity than chromosomal microarray (CMA) in autism spectrum disorder (ASD) but are costlier and result interpretation can be uncertain. Study objective was to compare the costs and outcomes of four genetic testing strategies in children with ASD. METHODS A microsimulation model estimated the outcomes and costs (in societal and public payer perspectives in Ontario, Canada) of four genetic testing strategies: CMA for all, CMA for all followed by ES for those with negative CMA and syndromic features (CMA+ES), ES or GS for all. RESULTS Compared to CMA, the incremental cost-effectiveness ratio (ICER) per additional child identified with rare pathogenic variants within 18 months of ASD diagnosis was $CAN5997.8 for CMA+ES, $CAN13,504.2 for ES and $CAN10,784.5 for GS in the societal perspective. ICERs were sensitive to changes in ES or GS diagnostic yields, wait times for test results or pre-test genetic counselling, but were robust to changes in the ES or GS costs. CONCLUSION Strategic integration of ES into ASD care could be a cost-effective strategy. Long wait times for genetic services and uncertain utility, both clinical and personal, of sequencing results could limit broader clinical implementation.
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Affiliation(s)
- Tracy Yuen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11/F, 686 Bay St, Toronto, M5G 0A4, Canada
| | - Melissa T Carter
- Regional Genetics Program, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Peter Szatmari
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11/F, 686 Bay St, Toronto, M5G 0A4, Canada
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11/F, 686 Bay St, Toronto, M5G 0A4, Canada.
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19
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Lim KK, Yoon SY, Mohd Taib NA, Shabaruddin FH, Dahlui M, Woo YL, Thong MK, Teo SH, Chaiyakunapruk N. Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:395-406. [PMID: 29572724 DOI: 10.1007/s40258-018-0384-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. METHODS We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. RESULTS In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. CONCLUSIONS Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.
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Affiliation(s)
- Ka Keat Lim
- Health Systems and Services Research, Duke NUS Medical School, 8 College Road, 169857, Singapore, Republic of Singapore
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd Floor, MMA House, 124 Jalan Pahang, 53000, Kuala Lumpur, Malaysia
| | - Sook Yee Yoon
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Fatiha Hana Shabaruddin
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Meow Keong Thong
- Department of Paediatrics, Faculty Of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Muang, Phitsanulok, Thailand.
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform , Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- School of Pharmacy, University of Wisconsin, Madison, USA.
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20
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Guglielmo A, Staropoli N, Giancotti M, Mauro M. Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:2. [PMID: 29386984 PMCID: PMC5778687 DOI: 10.1186/s12962-018-0085-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/03/2018] [Indexed: 01/03/2023] Open
Abstract
Background Due to its epidemiological relevance, several studies have been performed to assess the cost-effectiveness of diagnostic tests and treatments in colorectal cancer (CRC) patients. Objective We reviewed economic evaluations on diagnosis of inherited CRC-syndromes and genetic tests for the detection of mutations associated with response to therapeutics. Methods A systematic literature review was performed by searching the main literature databases for relevant papers on the field, published in the last 5 years. Results 20 studies were included in the final analysis: 14 investigating the cost-effectiveness of hereditary-CRC screening; 5 evaluating the cost-effectiveness of KRAS mutation assessment before treatment; and 1 study analysing the cost-effectiveness of genetic tests for early-stage CRC patients prognosis. Overall, we found that: (a) screening strategies among CRC patients were more effective than no screening; (b) all the evaluated interventions were cost-saving for certain willingness-to-pay (WTP) threshold; and (c) all new CRC patients diagnosed at age 70 or below should be screened. Regarding patients treatment, we found that KRAS testing is economically sustainable only if anticipated in patients with non-metastatic CRC (mCRC), while becoming unsustainable, due to an incremental cost-effectiveness ratio (ICER) beyond the levels of WTP-threshold, in all others evaluated scenarios. Conclusions The poor evidence in the field, combined to the number of assumptions done to perform the models, lead us to a high level of uncertainty on the cost-effectiveness of genetic evaluations in CRC, suggesting that major research is required in order to assess the best combination among detection tests, type of genetic test screening and targeted-therapy. Electronic supplementary material The online version of this article (10.1186/s12962-018-0085-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annamaria Guglielmo
- Department of Clinical and Experimental Medicine, "Magna Græcia" University, Viale Europa 88100, Catanzaro, Italy
| | - Nicoletta Staropoli
- Department of Clinical and Experimental Medicine, "Magna Græcia" University, Viale Europa 88100, Catanzaro, Italy
| | - Monica Giancotti
- Department of Clinical and Experimental Medicine, "Magna Græcia" University, Viale Europa 88100, Catanzaro, Italy
| | - Marianna Mauro
- Department of Clinical and Experimental Medicine, "Magna Græcia" University, Viale Europa 88100, Catanzaro, Italy
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21
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Hughes DA, Plumpton CO. Rare disease prevention and treatment: the need for a level playing field. Pharmacogenomics 2018; 19:243-247. [PMID: 29327657 DOI: 10.2217/pgs-2017-0300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pharmacogenetic tests are being used increasingly to prevent rare and potentially life-threatening adverse drug reactions. For many tests, however, cost-effectiveness is hard to demonstrate, and with the exception of a few cases, widespread implementation remains a distant prospect. Many orphan drugs for rare diseases are also not cost effective but are nonetheless normally reimbursed. In this article, we argue that the health technology assessment of pharmacogenetic tests aimed to prevent rare but severe adverse drug reactions should be on a level playing field with orphan drugs. This is supported by a number of arguments, concerning the severity, rarity and iatrogenic nature of adverse drug reactions, the distribution of benefits and costs and societal preference towards prevention over treatment.
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Affiliation(s)
- Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Ardudwy, Normal Site, Bangor University, Holyhead Road, Bangor, Gwynedd, LL57 2PZ, Wales, UK
| | - Catrin O Plumpton
- Centre for Health Economics & Medicines Evaluation, Ardudwy, Normal Site, Bangor University, Holyhead Road, Bangor, Gwynedd, LL57 2PZ, Wales, UK
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Gavan SP, Thompson AJ, Payne K. The economic case for precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018; 3:1-9. [PMID: 29682615 PMCID: PMC5890303 DOI: 10.1080/23808993.2018.1421858] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/22/2017] [Indexed: 11/17/2022]
Abstract
Introduction: The advancement of precision medicine into routine clinical practice has been highlighted as an agenda for national and international health care policy. A principle barrier to this advancement is in meeting requirements of the payer or reimbursement agency for health care. This special report aims to explain the economic case for precision medicine, by accounting for the explicit objectives defined by decision-makers responsible for the allocation of limited health care resources. Areas covered: The framework of cost-effectiveness analysis, a method of economic evaluation, is used to describe how precision medicine can, in theory, exploit identifiable patient-level heterogeneity to improve population health outcomes and the relative cost-effectiveness of health care. Four case studies are used to illustrate potential challenges when demonstrating the economic case for a precision medicine in practice. Expert commentary: The economic case for a precision medicine should be considered at an early stage during its research and development phase. Clinical and economic evidence can be generated iteratively and should be in alignment with the objectives and requirements of decision-makers. Programmes of further research, to demonstrate the economic case of a precision medicine, can be prioritized by the extent that they reduce the uncertainty expressed by decision-makers.
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Affiliation(s)
- Sean P. Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexander J. Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Borsci S, Uchegbu I, Buckle P, Ni Z, Walne S, Hanna GB. Designing medical technology for resilience: integrating health economics and human factors approaches. Expert Rev Med Devices 2017; 15:15-26. [PMID: 29243500 DOI: 10.1080/17434440.2018.1418661] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered: Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology. This approach (Human and Economic Resilience Design for Medical Technology or HERD MedTech) supports early stages of product development and is based on the recent experiences of the National Institute for Health Research London Diagnostic Evidence Co-operative in the UK. Expert commentary: HERD MedTech i) proposes a shift from design for usability to design for resilience, ii) aspires to reduce the need for service adaptation to technological constraints iii) ensures value of innovation at the time of product development, and iv) aims to stimulate discussion around the integration of pre- and post-market methods of assessment of medical technology.
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Affiliation(s)
- Simone Borsci
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Ijeoma Uchegbu
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Peter Buckle
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Zhifang Ni
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Simon Walne
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - George B Hanna
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
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Tan SY, Melendez-Torres GJ. Do prospective payment systems (PPSs) lead to desirable providers’ incentives and patients’ outcomes? A systematic review of evidence from developing countries. Health Policy Plan 2017; 33:137-153. [DOI: 10.1093/heapol/czx151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 12/29/2022] Open
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A review of international coverage and pricing strategies for personalized medicine and orphan drugs. Health Policy 2017; 121:1240-1248. [PMID: 29033060 DOI: 10.1016/j.healthpol.2017.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 08/12/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Personalized medicine and orphan drugs share many characteristics-both target small patient populations, have uncertainties regarding efficacy and safety at payer submission, and frequently have high prices. Given personalized medicine's rising importance, this review summarizes international coverage and pricing strategies for personalized medicine and orphan drugs as well as their impact on therapy development incentives, payer budgets, and therapy access and utilization. METHODS PubMed, Health Policy Reference Center, EconLit, Google Scholar, and references were searched through February 2017 for articles presenting primary data. RESULTS Sixty-nine articles summarizing 42 countries' strategies were included. Therapy evaluation criteria varied between countries, as did patient cost-share. Payers primarily valued clinical effectiveness; cost was only considered by some. These differences result in inequities in orphan drug access, particularly in smaller and lower-income countries. The uncertain reimbursement process hinders diagnostic testing. Payer surveys identified lack of comparative effectiveness evidence as a chief complaint, while manufacturers sought more clarity on payer evidence requirements. Despite lack of strong evidence, orphan drugs largely receive positive coverage decisions, while personalized medicine diagnostics do not. CONCLUSIONS As more personalized medicine and orphan drugs enter the market, registries can provide better quality evidence on their efficacy and safety. Payers need systematic assessment strategies that are communicated with more transparency. Further studies are necessary to compare the implications of different payer approaches.
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Oliveira MRF, Leandro R, Decimoni TC, Rozman LM, Novaes HMD, De Soárez PC. Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results? Clinics (Sao Paulo) 2017; 72:499-509. [PMID: 28954010 PMCID: PMC5577617 DOI: 10.6061/clinics/2017(08)08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/06/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.
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Affiliation(s)
- Maria Regina Fernandes Oliveira
- Faculdade de Medicina, Universidade de Brasilia, Campus Universitario Darcy Ribeiro, Brasilia, DF, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
| | - Roseli Leandro
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital de Transplantes Euryclides de Jesus Zerbini, Sao Paulo, SP, BR
| | - Tassia Cristina Decimoni
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciana Martins Rozman
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hillegonda Maria Dutilh Novaes
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
| | - Patrícia Coelho De Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Avaliacao de Tecnologias em Saude (IATS/CNPq), Porto Alegre, RS, BR
- *Corresponding author. E-mail:
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Steuten LMG. Early Stage Health Technology Assessment for Precision Biomarkers in Oral Health and Systems Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2016; 20:30-5. [PMID: 26760958 DOI: 10.1089/omi.2015.0174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Health technology assessment (HTA) is a crucial science that influences the responsible and evidence-based transition of new discoveries from laboratory to applications in the clinic and society. HTA has recently moved "upstream" so as to assess technologies from their onset at their discovery, design, or planning phase. Biomarker research is relatively recent in oral health, but growing rapidly with investments made to advance dentistry and oral health and importantly, to build effective bridges between oral health and systems medicine since what happens in oral health affects systems pathophysiology, and vice versa. This article offers a synthesis of the latest trends and approaches in early phase HTA, with a view to near future applications in oral health, systems medicine, and biomarker-guided precision medicine. In brief, this review underscores that demonstrating health outcomes of biomarkers and next-generation diagnostics is particularly challenging because they do not always influence long-term outcomes directly, but rather impact subsequent care processes. Biomarker testing costs are typically less of a barrier to uptake in practice than the biomarker's impact on longer term health outcomes. As a single biomarker or next-generation diagnostic in oral health can inform decisions about numerous downstream diagnosis-treatment combinations, early stage "upstream" HTA is crucial in prioritizing the most valuable diagnostic applications to pursue first. For the vast array of oral health biomarkers currently developed, early HTA is necessary to timely and iteratively assess their comparative effectiveness and anticipate the inevitable questions about value for money from regulators and payers.
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Affiliation(s)
- Lotte M G Steuten
- 1 Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research , Seattle, Washington, United States .,2 School of Pharmacy, University of Washington , Seattle, Washington, United States .,3 Panaxea bv , Enschede, The Netherlands
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