Economic Dimensions of Personalized and Precision Medicine

Economic Dimensions of Personalized and Precision Medicine

Ernst R. Berndt, Dana P. Goldman, and John Rowe

Print publication date: 2019

ISBN: 9780226611068

Publisher: University of Chicago Press

Abstract

Advances in human genetics have begun to yield clinical benefits through the development of Precision Medicine (PM). The benefits of this innovation are promising, both through application of constitutional genetics detecting mutations that affect the risk of disease and tumor genetics, and malignancy-causing mutations susceptible to targeted therapies. While PM may ultimately be used in all aspects of medicine, to date, the most fruitful applications have been in maternal-fetal medicine and cancer. However, due to the complexity and cost of developing these innovations, and to privacy issues, advancing PM is a challenge in traditional clinical, reimbursement, and regulatory landscapes. Although much of the literature focuses on challenges in relating constellations of mutations to the identification of actual current or potential disease states, and to the efficacy of treatments, diffusion of PM also depends on many non-clinical factors. For example, how will information on accurate diagnosis and treatment success be disseminated, and who will bear the cost? How might physician training change to incorporate genetic, probability, statistics, and economic considerations? How can patients reconcile with the ethical and privacy concerns related to the availability of genetic information? Will the era of PM yield still more disparities in access to care? Will cost-effectiveness analysis need to change to better take into account patient heterogeneity? This volume explores the intersection of the scientific, clinical, and economic factors to consider in developing PM. We explore the theoretical and historical underpinnings of PM, discuss implementation issues, and present examples of real-world applications.

Table of Contents

Introduction

Ernst R. Berndt, Dana P. Goldman, and John W. Rowe

2 Therapeutic Translation of Genomic Science

Manuel Hermosilla and Jorge Lemus

3 The Value of Pharmacogenomic Information

John A. Graves, Zilu Zhou, Shawn Garbett, and Josh F. Peterson

5 Characterizing the Drug Development Pipeline for Precision Medicines

Amitabh Chandra, Craig Garthwaite, and Ariel Dora Stern

8 Physicians’ Financial Incentives to Personalize Medicine

David H. Howard, Jason Hockenberry, and Guy David

9 Economic Dimensions of Personalized and Precision Medicine in Asia

Jui-fen Rachel Lu (盧瑞芬‎), Karen Eggleston (翁笙和‎), and Joseph Tung-Chieh Chang (張東杰‎)

10 The Value of Cytochrome P450 2C19 Pharmacogenomic Information for Patients Receiving Clopidogrel Therapy Following a Major Cardiovascular Event

Rebecca A. Pulk, Jove Graham, Frank R. Lichtenberg, Daniel Maeng, Marc S. Williams, and Eric Wright