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Forum for Health Economics & Policy

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1558-9544
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Quantifying the Value of Personalized Medicines: Evidence from COX-2 Inhibitors

Neeraj Sood
  • Corresponding author
  • The University of Southern California, 3335 South Figueroa Street, University Park Campus, UGW-Unit A, Los Angeles, CA 90089, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tomas J. Philipson
  • Harris School of Public Policy, The University of Chicago, 1155 E, 60th Street, Chicago, IL 60637, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter Huckfeldt
Published Online: 2013-04-09 | DOI: https://doi.org/10.1515/fhep-2013-0005

Abstract

We develop a conceptual framework for estimating the value of personalized medicines. We show that personalizing medicines generates value from two sources. The first is a market-expansion effect by persons who initiate treatment due to reduced pre-treatment uncertainty about the effectiveness or side effects of treatment. The second is a market-contraction effect due to discontinuation of treatment by persons unresponsive to treatment. We apply the conceptual framework to evaluate the value of a predictive test to assess whether patients are at elevated risk for cardiac complications from COX-2 inhibitors. We find that this predictive test would yield an overall value to patients of about $16 billion per year or $1284 per likely patient.

Keywords: adverse events; diagnostics; innovation; personalized medicines; social value

References

  • Bresalier, R. S., R. S. Sandler, H. Quan, J. A. Bolognese, B. Oxenius, K. Horgan, C. Lines, R. Riddell, D. Morton, A. Lanas, M. A. Konstam, J. A. Baron and Adenomatous Polyp Prevention on Vioxx (APPROVe) Trial Investigators (2005) “Cardiovascular Events Associated with Rofecoxib in an Colorectal Adenoma Chemoprevention Trial,” New England Journal of Medicine, 352(11):1092–1102.Google Scholar

  • Brune, K., H. A. Katus, J. Moecks, E. Spanuth, A.S. Jaffe and E. Giannitsis (2008) “N-Terminal Pro-B-Type Natriuretic Peptide Concentrations Predict the Risk of Cardiovascular Adverse Events from Anti-inflammatory Drugs: A Pilot Trial,” Clinical Chemistry, 54(7):1149–1157.CrossrefPubMedWeb of ScienceGoogle Scholar

  • Cook, J., G. Hunter, J. A. Vernon (2009) “The Future Costs, Risks and Rewards of Drug Development: the Economics of Pharmacogenomics,” Pharmacoeconomics, 27(5):355–363.PubMedWeb of ScienceCrossrefGoogle Scholar

  • Danzon, P. and A. Towse (2002) “The Economics of Gene Therapy and of Pharmacogenetics,” Value in Health, 5(1):5–13.Google Scholar

  • de Lemos, J. A., D. A. Morrow, J. H. Bentley, T. Omland, M. S. Sabatine, C. H. McCabe, C. Hall, C. P. Cannon and E. Braunwald (2001) “The Predictive Value of B-Type natriuretic Peptide in Patients with Acute Coronary Syndromes,” New England Journal of Medicine, 345:1014–1021.Google Scholar

  • Elkin, E. B., M. C. Weinstein, E.P. Winer, K.M. Kuntz, S. J. Schnitt and J. C. Weeks (2004) “HER-2 Testing and Trastuzumab Therapy for Metastatic Breast Cancer: a Cost-Effectiveness Analysis,” Journal of Clinical Oncology, 22(5):854–863.CrossrefGoogle Scholar

  • Fenwick, E., B. J. O’Brien and A. Briggs (2004) “Cost-Effectiveness Acceptability Curves – Facts, Fallacies and Frequently asked Questions,” Health Economics, 13(5):405–415.PubMedCrossrefGoogle Scholar

  • Gafni, A., C. Charles and T. Whelan (1998) “The Physician-Patient Encounter: The Physician as a Perfect Agent for the Patient Versus the Informed Treatment Decision Making Model,” Social Science and Medicine, 47(3):347–354.CrossrefGoogle Scholar

  • Garrison Jr, L. P. and M. J. F. Austin (2007) “The Economics of Personalized Medicine: A Model of Incentives for Value Creation and Capture,” Drug Information Journal, 41(4):501–509.Google Scholar

  • Hirth, R. A., M. E. Chernew, E. Miller, A. M. Fendrick and W. G. Weissert (2000) “Willingness to Pay for a Quality-Adjusted Life Year: in Search of a Standard,” Med Decis Making, 20(3):332–342.CrossrefPubMedGoogle Scholar

  • Kemp, L. K., C. M. Doran, T. Vos and W. Hall (2007) “Cost-Effectiveness Analysis of Genetic Screening for the Taq1B Polymorphism in the Secondary Prevention of Coronary Heart Disease,” Expert Review of Pharmacoeconomics & Outcomes Research, 7(2):119–128.Google Scholar

  • Lampe, F. C., P. H. Whincup, S. G. Wannamethee, A. G. Shaper, M. Walker and S. Ebrahim (2000) “The Natural History of Prevalent Ischaemic Heart Disease in Middle-Aged Men,” European Heart Journal, 21:1052–1062.CrossrefPubMedGoogle Scholar

  • Latimer, N., R. L. Grant, J. Lord, R. O’Mahony, J. Dickson, P. G. Conaghan and on behalf of the National Institute for Health and Clinical Excellence Osteoarthritis Guideline Development Group (2009) “Cost Effectiveness of COX 2 Selective Inhibitors and Traditional NSAIDS alone or in Combination with a Proton Pump Inhibitor for People with Osteoarthritis,” British Medical Journal, 339. doi: http://dx.doi.org/10.1136/bmj.b2538 (Published 14 July 2009).CrossrefWeb of Science

  • Motsko, S. P., K. L. Rascati, A. J. Busti, J. P. Wilson, J. C. Barner, K. A. Lawson and J. Worchel (2006) “Temporal Relationship between use of NSAIDs, Including Selective COX-2 Inhibitors and Cardiovascular Risk,” Drug Safety, 29(7):621–632.CrossrefGoogle Scholar

  • Nussmeier, N. A., A. A. Whelton, M. T. Brown, R. M. Langford, A. Hoeft, J. L. Parlow, S. W. Boyce and K. M. Verburg (2005) “Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac Surgery,” New England Journal of Medicine, 352(11):1071–1080.Google Scholar

  • Pignone, M., S. Earnshaw, J. A. Tice and M. J. Pletcher (2006) “Aspirin, Statins, or Both Drugs for the Primary Prevention of Coronary Heart Disease Events in Men: A Cost-Utility Analysis,” Annals of Internal Medicine, 144:326–336.Google Scholar

  • Psaty, B. M. and C. D. Furberg (2005) “COX-2 Inhibitors- Lessons in Drug Safety,” New England Journal of Medicine, 352(11):1133–1134.Google Scholar

  • Rosenberg, J., M. Schou, F. Gustafsson, J. Badskjær and P. Hildebrandt (2009) “Prognostic Threshold levels of NT-proBNP Testing in Primary Care,” Europe Heart Journal, 30(1):66–73.Google Scholar

  • Ruff, C. T., D. A. Morrow, P. Jarolim, F. Ren, C. F. Contant, A. Kaur, S. P. Curtis, L. Laine, C. P. Cannon and K. Brune (2011) “Evaluation of NT-proBNP and High Sensitivity C-Reactive Protein for Predicting Cardiovascular Risk in Patients with Arthritis Taking Long-term Nonsteroidal Anti-inflamatory Drugs,” The Journal of Rheumatology, 38(6):1071–1078.CrossrefWeb of ScienceGoogle Scholar

  • Sax, P. E., R. Islam, R. P. Walensky, E. Losina, M. C. Weinstein, S. J. Goldie, S. N. Sadownik and K. A. Freedberg (2005) “Should Resistance Testing be Performed for Treatment-Naive HIV-Infected Patients? A Cost-Effectiveness Analysis,” Clinical Infectious Diseases, 41(9):1316–1323.CrossrefGoogle Scholar

  • Solomon, S. D., J. J. McMurray, M. A. Pfeffer, J. Wittes, R. Fowler, P. Finn, W. F. Anderson, A. Zauber, E. Hawk, M. Bertagnolli and Adenoma Prevention with Celecoxib (APC) Study Investigators (2005) “Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention,” New England Journal of Medicine, 352(11):1071–1080.Google Scholar

  • Stallings, S. C., D. Huse, S. N. Finkelstein, W. H. Crown, W. P. Witt, J. Maguire, A. J. Hiller, A. J. Sinskey and G. S. Ginsburg (2006) “A Framework to Evaluate the Economic Impact of Pharmacogenomics,” Pharmacogenomics, 7(6):853–862.PubMedCrossrefGoogle Scholar

  • Trusheim, M. R., E. R. Berndt and F. L. Douglas (2007) “Stratified Medicine: Strategic and Economic Implications of Combining Drugs and Clinical Biomarkers,” Nature Reviews Drug Discovery, 6(4):287–293.CrossrefPubMedWeb of ScienceGoogle Scholar

  • Wong, W. B., J. J. Carlson, R. Thariani and D. L. Veenstra (2010) “Cost Effectiveness of Pharmacogenomics: a Critical and Systematic Review,” Pharmacoeconomics, 28(11):1001–1013.CrossrefWeb of SciencePubMedGoogle Scholar

About the article

Corresponding author: Neeraj Sood, The University of Southern California, 3335 South Figueroa Street, University Park Campus, UGW-Unit A, Los Angeles, CA 90089, USA, Phone: +213 821 7949; Fax: +213 740 3460, e-mail:


Published Online: 2013-04-09

Published in Print: 2013-01-01


Risk-averse consumers will also benefit from reduction in uncertainty about treatment benefits. Similarly, reduced uncertainty about treatment response might also increase adherence to treatment.

In a sensitivity analysis, we limited the analysis to patients with two or more prescriptions in a year; the overall numbers fell, but the fractions Current and Potential were similar.

Using the MEPS Prescribed Medicines Component, the average price per 200 mg Celebrex pill in 2006 and 2007 was $3.36 and $3.38, respectively. The typical recommended dosage is one 200 mg pill per day. Aggregating over 365 days, this is approximately $1200 in annual spending on Celebrex.

Medicare reimbursement for the test is $49.56 (HCPC code 83880). http://www.cms.hhs.gov/ClinicalLabFeesched/02_clinlab.asp.

http://www.hospitalcompare.hhs.gov.

2/3 of patients are Current, 1/3 will be at increased risk, thus 2/9 of all patients will discontinue use. 1/3 of patients are Potential, 2/3 will not be at risk, thus 2/9 will initiate use, leading to no change in overall use.

Medicare reimbursement for the test is $49.56 (HCPC code 83880). http://www.cms.hhs.gov/ClinicalLabFeesched/02_clinlab.asp.


Citation Information: Forum for Health Economics and Policy, ISSN (Online) 1558-9544, ISSN (Print) 2194-6191, DOI: https://doi.org/10.1515/fhep-2013-0005.

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