Using genomic information to guide ibrutinib treatment decisions in chronic lymphocytic leukaemia

A quick update for you on my PhD publications. Last year, I completed my PhD which considered the issues surrounding the economic analysis of genomic diagnostic technologies in the UK NHS. So far, I have published three papers reporting the results of this work:

I am pleased to be able to report that the fourth paper arising from my PhD work was published today in PharmacoEconomics, titled: “Using genomic information to guide ibrutinib treatment decisions in chronic lymphocytic leukaemia: A cost-effectiveness analysis“.


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Whole genome sequencing costs – a step in the right direction

It is now well documented that health economic evidence to inform commissioning decisions regarding genomic tests is in short supply. This lack of evidence relates to both costs and health outcomes – there is perhaps an understandable tendency to focus on the issues surrounding the measurement of health outcomes in genomics, but data on costs is equally sparse and the generation of such data is also beset by practical and methodological challenges. That said, in the past twelve months we have started to finally see some good quality data emerging on the costs of whole genome and whole exome sequencing, and a recent paper by Kate Tsiplova and colleagues has made a notable contribution to this literature.

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The cost-effectiveness of next generation sequencing in colorectal cancer

So, apologies again for the radio silence. Good news though: the PhD has finally been submitted! That’s not quite the end of that chapter in my life though, as I still have a viva to complete and six more publications to prepare to add to the two that have been published in the last 18 months or so. Hopefully I’ll be able to share more of my PhD outputs from the start of 2016 onwards, depending (of course) on the vagaries of the peer-review process.

Anyway, I now have time to read and then write about all of the publications that I’ve been putting to one side over the last few months. I’m going to start with a paper by Carlos Gallego et al. which was published in JCO in May, and which considered the cost-effectiveness of next generation sequencing (NGS) panels for the diagnosis of colorectal cancer and polyposis (CRCP) syndromes.

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Genomics at the 2015 iHEA meeting in Milan

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. Continue reading

Cost-effectiveness analysis and genetics – the zombie technique that will never die

Terry Flynn recently blogged on how treatment tailored to genes will kill economic evaluation. It’s a catchy title that I hope will draw health economists working outside of genetics into a growing debate on the best way to do economic evaluation in genetics and genomics. However, I don’t entirely agree with everything that Terry said and wanted to respond on a few points:

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Personalised Medicine and Resource Allocation

Yesterday in Oxford we hosted a conference titled “Personalised Medicine and Resource Allocation”. The conference aimed to explore the challenges of implementing genomic medicine into widespread clinical practice, and there was a particular focus on the generation of economic evidence and the ethical issues that arise in the resource allocation decisions required to allow personalised medicine to be realised.

I was pleased to be asked to speak at the event, and I presented alongside Jilles Fermont on “Methodological issues surrounding the health economic evaluation of genomic technologies and a case study of these issues in the research setting”. It was an interesting day overall, and I suspect that others will blog more extensively on the various topics that were discussed. For now, I’ll leave a link to our slides, in case anybody is interested in this topic. For more information on the day itself, please visit the conference website or follow the proceedings on Twitter via the hashtag #PMRAoxford.

Welfarism versus extra-welfarism: an important analytical decision in genomics?

In my first blog post, I posed a number of questions that were relevant in health economics and genomics. One of these was “Is there a greater role for cost-benefit analysis in genomics?”. I’m working towards contributing to this debate with my PhD (if I ever finish), and one of the byproducts of my PhD is this paper, published over the weekend in PharmacoEconomics, titled: “Welfarism Versus Extra-Welfarism: Can the Choice of Economic Evaluation Approach Impact on the Adoption Decisions Recommended by Economic Evaluation Studies?”. I hope it mght be relevant to other health economists working in genomics, so I thought I would share it here. There are (hopefully!) a few findings of note, but I guess the main take-home message is this: “We found that for every five studies applying both approaches, one shows limited or no concordance in economic evaluation results: the different approaches suggest conflicting adoption decisions, and there is no pattern to which approach provides the most convincing adoption evidence”. It certainly provides food for thought when designing economic evaluations in genomics.