Download Louis Niessen MD PhD Management, Erasmus MC, Erasmus University,

PERSONALISED MEDICINES SYMPOSIUM
Warwick Medical School
Medical Teaching Centre, University of Warwick
Wednesday 5th July 2006
Louis Niessen MD PhD
Institute for Medical Technology Assessment / Institute of Health Policy and
Management, Erasmus MC, Erasmus University,
PO Box 1738, 3000 DR, Rotterdam, The Netherlands
Email: [email protected]
www.bmg.eur.nl/personal/niessen
Economic evaluation of existing and future pharmacogenomics-based
treatment strategies: Can there be a generic approach?
Ken Redekop, PhD and Louis Niessen, MD, PhD
Pharmacogenomics tests help to identify patients who will experience important
adverse events or who obtain important benefit from drug therapy. For this reason,
pharmacogenomics can be viewed as an important means to improve overall
effectiveness, safety and cost-effectiveness of many drug therapies. However, policy
makers will raise the issue of the actual utility of pharmacogenomics in specific
patient situations before widespread admission to clinical practice. In health
technology assessment, utility can be defined in different ways, including health gain
(e.g., quality of life, QALYs) and cost-effectiveness. In both cases, it is important to
remember that pharmacogenomics is not a treatment but more a specialised
diagnostic test. Health gain is achieved by making better decisions about therapy.
Degree of health gain attainable using pharmacogenomics is therefore dependent on
the effectiveness and safety of available therapies. In fact, the potential health gain
attainable via pharmacogenomics is dependent on various factors, including the test's
sensitivity and specificity, disease prognosis (with or without therapy), and the
patient population. Cost-effectiveness of pharmacogenomics testing is dependent on
the same factors, as well as the costs of the test and the programme, the treatment
and the disease. Development of a generic decision approach would help to
standardise and catalyse the estimation of health benefit distribution and costeffectiveness of treatment strategies using existing pharmacogenomics tests and
subsequent treatments. The economic methodologies also help to quantify the
uncertainty surrounding these estimates. While pharmacogenomics offers exciting
opportunities to provide tailor-made medicine, it might not be always be beneficial
and its utility will vary greatly between applications. This model could also help in
priority setting during the development of new tests, by estimating the potential
health gain and cost-effectiveness of pharmacogenomics tests long before these tests
exist or have been fully developed.