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Forum for Health Economics & Policy

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CiteScore 2016: 0.30

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The Value of Diagnostic Testing in Personalized Medicine

Dana P. Goldman
  • Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
/ Charu Gupta
  • Precision Health Economics, Los Angeles, CA, USA
/ Eshan Vasudeva
  • Precision Health Economics, Los Angeles, CA, USA
/ Kostas Trakas
  • Janssen Diagnostics, Toronto, ON, Canada and Philadelphia, PA, USA
/ Ralph Riley
  • Janssen Diagnostics, Toronto, ON, Canada and Philadelphia, PA, USA
/ Darius Lakdawalla
  • Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
/ David Agus
  • Center for Applied Molecular Medicine, University of Southern California, Los Angeles, CA, USA
/ Neeraj Sood
  • Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
/ Anupam B. Jena
  • Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
/ Tomas J. Philipson
  • Corresponding author
  • Harris School of Public Policy, The University of Chicago, 1155 East 60th Street, Chicago, IL 60637, USA
  • Email:
Published Online: 2013-09-14 | DOI: https://doi.org/10.1515/fhep-2013-0023

Abstract

Personalized medicine – the targeting of therapies to individuals on the basis of their biological, clinical, or genetic characteristics – is thought to have the potential to transform health care. While much emphasis has been placed on the value of personalized therapies, less attention has been paid to the value generated by the diagnostic tests that direct patients to those targeted treatments. This paper presents a framework derived from information economics for assessing the value of diagnostics. We demonstrate, via a case study, that the social value of such diagnostics can be very large, both by avoiding unnecessary treatment and by identifying patients who otherwise would not get treated. Despite the potential social benefits, diagnostic development has been discouraged by cost-based, rather than value-based, reimbursement.

Keywords: diagnostics; personalized medicine; social value; value-based reimbursement

References

  • Aspinall, M. G. and R. G. Hamermesh (2007) “Realizing the Promise of Personalized Medicine,” Harvard Business Review, 85(10):108–117.

  • 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 Antiinflammatory Drugs: A Pilot Trial,” Clinical Chemistry, 54(7):1149–1157. [Crossref] [Web of Science] [PubMed]

  • Carlson, J. J., L. P. Garrison Jr and S. D. Sullivan (2009) “Paying for Outcomes: Innovative Coverage and Reimbursement Schemes for Pharmaceuticals,” Journal of Management Care Pharmacology, 15(8):683.

  • Davis, J.C., L. Furstenthal, A. A. Desai, T. Norris, S. Sutaria, E. Fleming and P. Ma (2009) “The Microeconomics of Personalized Medicine: Today’s Challenge and Tomorrow’s Promise,” Natural Review Drug Discovery, 8(4):279–286.

  • 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.

  • Epstein, R. S., T. P. Moyer, R. E. Aubert, D. J. Okane, F. Xia, R. R. Verbrugge, B. F. Gage and J. R. Teagarden (2010) “Warfarin Genotyping Reduces Hospitalization Rates Results from the MM-WES (Medco-Mayo Warfarin Effectiveness Study),” Journal of the American College of Cardiology, 55(25):2804–2812. [Web of Science] [Crossref]

  • Faulkner, E. (2009) “Clinical Utility or Impossibility? Addressing the Molecular Diagnostics Assessment and Reimbursement Conundrum,” Journal of Managed Care Medicine, 12(4): 42–.

  • Gardiner, S. J. and E. J. Begg (2005) “Pharmacogenetic Testing for Drug Metabolizing Enzymes: Is It Happening in Practice?” Pharmacogenetics and Genomics, 15(5):365. [Crossref]

  • Gaughan, E. M. and D. B. Costa (2011) “Genotype-Driven Therapies for Non-Small Cell Lung Cancer: Focus on EGFR, KRAS and ALK Gene Abnormalities,” Therapeutic Advances in Medical Oncology, 3(3):113–125.

  • Health Advances (2010) “The Reimbursement Landscape for Novel Diagnostics.”

  • Hudis, C. A. (2007) “Trastuzumab – Mechanism of Action and Use in Clinical Practice,” New England Journal of Medicine, 357(1):39–51.

  • Institute of Medicine (2010) Policy Issues in the Development of Personalized Medicine in Oncology: Workshop Summary. Washington, DC: The National Academies Press.

  • 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 and Outcomes Research, 7(2):119–128.

  • Lakdawalla, D. N., E. C. Sun, A. B. Jena, C. M. Reyes, D. P. Goldman and T. J. Philipson (2010) “An Economic Evaluation of the War on Cancer,” Journal of Health Economics, 29(3):333–346. [Crossref]

  • McCabe, L. L. and E. R. McCabe (2008) “Expanded Newborn Screening: Implications for Genomic Medicine,” Annual Review of Medicine, 59:163–175. [Web of Science]

  • McGhee, S. A., E. R. Stiehm and E. R. McCabe (2005) “Potential Costs and Benefits of Newborn Screening for Severe Combined Immunodeficiency,” The Journal of Pediatrics, 147(5): 603–608. [Crossref]

  • Nelson, P. (1970) “Information and Consumer Behavior,” Journal of Political Economy, 78(2):311–329. [Crossref]

  • Philipson, T. J. and A. B. Jena (2005) “Who Benefits from New Medical Technologies? Estimates of Consumer and Producer Surpluses for HIV/AIDS Drugs,” NBER Working Paper Series, No. 11810.

  • Psaty, B. M. and C. D. Furberg (2005) “COX-2 Inhibitors – Lessons in Drug Safety,” New England Journal of Medicine, 352(11):1133–1135.

  • 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 Longterm Nonsteroidal Antiinflammatory Drugs,” Journal of Rheumatology, 38(6):1071–1078. [Crossref] [Web of Science]

  • Seabury, S. A., D. P. Goldman, J. R. Maclean, J. R. Penrod and D. N. Lakdawalla (2012) “Patients Value Metastatic Cancer Therapy more Highly than is Typically shown through Traditional Estimates,” Health Affairs, 31(4):691–699. [Crossref] [Web of Science]

  • Sood, N., T. Philipson and P. Huckfeldt (2013) “Quantifying the Value of Personalized Medicines: Evidence from COX-2 Inhibitors,” Forum for Health Economics and Policy, 16(1):1–22.

  • The Lewin Group (2005) The Value of Diagnostics Innovation, Adoption and Diffusion into Health Care, Prepared for the Advanced Medical Technology Association.

  • U.S. Food and Drug Administration (2004) Safety of Vioxx: FDA Public Health Advisory. Washington, DC.

  • UnitedHealth Group (2012) “Personalized Medicine: Trends and Prospects for the New Science of Genetic Testing and Molecular Diagnostics,” Working Paper 7.

About the article

Corresponding author: Tomas J. Philipson, Harris School of Public Policy, The University of Chicago, 1155 East 60th Street, Chicago, IL 60637, USA, e-mail:


Published Online: 2013-09-14

Published in Print: 2013-09-01


For example, HercepTest is an assay to determine HER2 protein overexpression in breast cancer tissue. Only breast cancer patients who overexpress HER2 respond to therapy with Herceptin (trastuzumab), a monoclonal antibody (Hudis 2007).


Citation Information: Forum for Health Economics and Policy, ISSN (Online) 1558-9544, ISSN (Print) 2194-6191, DOI: https://doi.org/10.1515/fhep-2013-0023. Export Citation

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[1]
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Forum for Health Economics and Policy, 2015, Volume 0, Number 0
[2]
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