iHEA Milan 2015
11th World Congress: "De Gustibus Disputandum Non Est!" Health Economics and Nutrition: an iHEA World Congress, 12-15 July 2015
HERC Sessions and Presentations
Organised Session - Sarah Wordsworth, James Buchanan
Personalised 'Genomic' Medicine: How is health economics determining its value?
The session brought together 4 presentations with the overarching theme of using genomic technologies in creating more personalised (stratified) medicine. Since the human genome was sequenced in 2001, the development of personalised medicine has been much slower than many experts predicted. The perceived factors contributing to their slow adoption into clinical practice, range from technical difficulties of the science and the need to handle a great deal of large and complex data, high cost of sequencing technologies, challenges in directly comparing alternative technologies often without using clinical trial methodology, regulatory and ethical issues, health technology assessment methodological challenges and general widespread confusion over reimbursement policies. Many of these factors are clearly in the realm of health economics and more recently have been magnified with the emergence of more advanced genome sequencing, next-generation sequencing (NGS). NGS includes targeted panels of genes, whole exome sequencing and whole genome sequencing. These technologies offer high throughput multiple gene testing at a speed never thought possible and have the potential to provide ‘better’ answers to clinical diagnosis and treatment questions. For instance they can more accurately detect mutations in genes for cancer patients leading to the use of more targeted drug therapies and enhanced ability to identify treatment responders. They can also provide a diagnosis for the first time for genetic rare diseases, when other largely single gene testing approaches such as Sanger sequencing have failed to do so. However, testing using NGS can yield a large amount of information, only some of which may be informative in answering the question for which the test was ordered and in some cases create uncertainty and increased complexity of clinical care. Whole genome sequencing in particular is increasingly dividing science and clinical communities. While the ability to sequence an individuals entire genome is tempting in a non-stop testing scenario, it brings with it concerns about secondary (incidental) findings which are extra to the initial clinical question being asked. Also, one could question whether it is necessary to sequence the entire genome, when a targeted sequencing approach could probably answer the main question being asked about a particular patient in front of the physician? Whilst there are many ethical and legal issues to consider with these more personalised genomic technologies, there are also huge health economic issues to consider, including what are the actual costs of NGS technologies and their actual clinical utility, what are the downstream costs and effects after the diagnosis stage, what is the actual ‘value’ of these technologies and how can we assess this value? This organised session brought together an international group of researchers who have been exploring the economic implications of personalised medicine for some time and have a great deal of practical and methodological experience to contribute to the debate.
Seamus Kent 'Hospital costs in relation to body mass index in 1.1 million women in England: a prospective cohort study'
James Buchanan 'Presenting risk information in discrete choice experiments: do graphical techniques influence willingness-to-pay?'
Ben Parker 'Management of low-grade dysplasia in ulcerative colitis in the uk national health service: The cost-effectiveness of immediate surgery versus ongoing surveillance'
Apostolos Tsiachristas 'Cost-effectiveness of disease management programs for cardiovascular risk and COPD in the Netherlands'
Ramon Luengo-Fernandez 'Is the current UK national screening programme for diabetic retinopathy cost-effective?'
Peter Eibich 'Effects of sports and exercise in different stages of appendicular lean mass and strength in the old - Data from the Berlin Aging Study II'
Sarah Wordsworth 'What behavioural traits are associated with the 'overuse' of antibiotics? A survey of population beliefs'
Sarah Wordsworth 'Whole Genome Sequencing: Where is it likely to provide the greatest value?'
Jose Leal 'Estimating long-term disease impact using administrative health datasets: hip fracture as a big data case study'