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.
evidence
Making better decisions in genomics
Happy New Year everybody. One of my new year’s resolutions is to post more frequently in 2015, and I’m going to start by taking a look at a recently published paper by Susan Snyder and colleagues titled “Economic evaluation of pharmacogenomics: a value-based approach to pragmatic decision making in the face of complexity”. This is a review paper that takes a look at the need for, and current use of economic evaluations in pharmacogenomics, identifying both obstacles to progress and also areas where, actually, we’re doing ok at the moment. There have been a few papers covering similar ground in the past couple of years (interested readers should check out Faulkner et al., Annemans et al. and, in a shameless act of self-promotion, one of my publications) and I think all of them have made a significant contribution to the literature in one way or another. Snyder et al. do so as well. Rather than review their paper in full, I wanted to focus on their unique contribution by pulling out a couple of points of interest that might prompt further discussion.
Concepts of ‘personalization’ in personalized medicine: implications for economic evaluation
In my introductory blog post, I noted that genomics might present new challenges for health economics and called for more discussion about appropriate methods in this context. I didn’t anticipate a particularly rapid response, but just a few days after posting I became aware of a new article published in PharmacoEconomics that engaged with many of the issues raised in my introductory post. Titled “Concepts of ‘personalization’ in personalised medicine: Implications for economic evaluations”, this paper reports the results of a workshop which considered where extensions to standard methods might be required in genomics and is a welcome addition to the limited existing literature on this subject. We covered some similar ground in a related paper published in Pharmacogenomics last year, and it is heartening to see that this new paper has reached some similar conclusions and developed a number of these issues further.
Health Economics and Genomics 