Apologies for the recent lack of blog posts. It turns out it takes a lot of effort to get a PhD written up alongside other research commitments. Normal service will be resumed very soon. For now, a few quick notes on the International Health Economics Association meeting in Milan which has just concluded. Specifically, this is a quick review of the presentations that I attended which had a link (however tenuous!) to genomics.
Patient Preferences and Patient-Centred Decision Making | Reed Johnson, Axel Muhlbacher, John Bridges | Link to abstracts
Not specifically focused on genomic testing, but the main thrust of this session was that decision-makers are increasingly considering patient preferences, and DCEs, best-worst scaling and other direct elicitation methods will have a greater role to play going forwards. So good news for those of us working in genomics, as there are a number of scenarios in which these methods will do a better job of demonstrating the benefits of genomic interventions than conventional approaches e.g. using QALYs/the EQ-5D.
What drives the cost of cancer treatment? | Paula Lorgelly | Link to abstract
Paula presented the first (health economic) results from Cancer 2015, a large-scale prospective longitudinal population-based molecular cohort study currently underway in Australia. This study is collecting genomic data on a large scale and linking this to administrative reimbursement data, so offers a lot of potential for interesting findings. The first results suggest that actionable mutations are a significant driver of cancer costs, which I guess we knew intuitively already but it’s great to be able to put some numbers on this. Keep an eye on this project for more interesting findings.
Personalised ‘Genomic’ Medicine: How is health economics determining its value? | Sarah Wordsworth, Adrian Towse, Lou Garrison, Wolf Rogowski | Link to abstracts
This was an organised session which covered a wide variety of issues related to economics and genomic technologies. These topics included how to value next generation sequencing technologies, where those technologies of greatest value might be found, and how the use of different approaches can drive suggested adoption decisions. I’d encourage you to take a look at the abstracts and then the publications of the presenters as there is a wealth of useful reading material there.
Exploring the evaluative framework within economic evaluation: the case of treatment for heroin users | Emma Frew | Link to abstract
Emma’s presentation wasn’t considering a genomic intervention, but her results are important for the work that we do in genomics. The key finding was that different economic evaluation approaches return different adoption decisions in a clinical context where there are a bunch of non-health benefits alongside the health benefits. As mentioned previously, this is likely to be the case for a number of genomic interventions, and my PharmacoEconomics paper earlier this year found a similar result. I’m looking forward to reading the final published version of Emma’s study.
Presenting risk information in DCEs: do graphical techniques influence WTP? | James Buchanan | Link to abstract
Disclaimer: this was me! Although not branded as a ‘genomics’ presentation, I was actually presenting some of the first results from a DCE evaluating the preferences of chronic lymphocytic leukaemia patients for the use of genomic testing to guide chemotherapy treatment decisions. The bottom line is that patients attach a large positive net benefit to genomic testing. From a DCE methodology perspective, this result varies considerably when risk graphics are used (or not). In fact, when risk graphics are not used, the positive net benefit disappears. I’m submitting this for publication shortly and I’ll provide a link here when it comes out.
Understanding risk-benefit trade-offs of genomic testing in chemotherapy treatment decisions for breast cancer: general population, cancer patients and medical oncologists | Ken Deal | Link to abstract
Ken presented a thorough review of preferences regarding chemotherapy treatment decisions in breast cancer. The key finding was that the provision of gene expression profiling information was valued by all three groups of respondents. Ken’s DCE also illustrated the difficulties associated with selecting appropriate attributes in a genomic context! I don’t think his analysis was complete, so I’ll look forward to hearing more about this study in the future.
Cost-effectiveness of methods in personalized medicine: results of a decision-analytic model in patients with AML | Laura Horster | Link to abstract
Laura’s presentation reported the results of an economic evaluation of the use of genomic testing to guide treatment decisions in AML. This was of particular interest to me as my PhD focuses on a similar research question in the context of chronic lymphocytic leukaemia. The key finding in Laura’s study was that genomic testing wasn’t cost-effective, although the results were presented slightly confusingly as an incremental cost per additional survival month. Revising this to a cost per life year gained would be helpful going forward, as would extending the analysis to incorporate QALYs (as this may help to demonstrate cost-effectiveness in this context). However, the results do agree with my results in chronic lymphocytic leukaemia, demonstrating again that as cheap as genomic testing can be, it’s the costs of the actions taken on the basis of test results that will drive cost-effectiveness.
Optimizing cost-effective implementation of pre-emptive genomic testing in medication prescribing decisions | Johnathan Schildcrout | Link to abstract
Finally, Johnathan presented a study looking at personalized pharmacogenomics testing strategies to guide statin and antiplatelet treatment. Again, this study is not yet finalised and the economic evaluation is yet to be undertaken, so the presentation focused on how best to identify those patients who were most suitable for testing. It was a little difficult to know what to take from this presentation, but I’ll keep an eye open for future publications.
So there you go, a very quick overview of iHEA2015 from the perspective of genomics. The linked abstracts provide a lot more detail on the respective presentations, as well as contact information for the authors. If you want to know more about my presentation, drop me on email.