Glasgow Molecular Pathology Node

"It's always too early until suddenly it's too late".  The case for early health economics assessment in precision medicine.

A new concept of translational health economics is emerging.  Sitting alongside the bench to bedside translation research process health economics can support the whole process through concept, prototype development, final product approval and implementation.  For medical technologies health economics is strongly associated with the final product stage when evaluation is required for agencies such as the National Institute for Health and Care Excellence (NICE) or the Scottish Medicines Consortium (SMC).  But there are benefits to beginning health economic evaluation at a much earlier stage as well as continuing its use to support the adoption of the technology in local contexts.

At concept stage, health economic evaluation can support the development of a coherent value proposition.  This is a statement of what kind of value the technology will add and can be useful to developers in raising investment.  For example, a biomarker test may be designed to test adherence to hypertension medication (as in Drugomics, a Glasgow Molecular Pathology Node supported project).  This test delivers value through informing the clinician that the patient is not adhering to the medication so allowing either a change of medication or an intervention to improve adherence.  The value here is delivered when there is a health outcome improvement as a result of the change in medication or other intervention.  The value proposition may differ in other disease areas where the knowledge that a patient is not adhering with a medication prevents a costly escalation of treatment.  If the health economic evaluation cannot articulate a clear value proposition (where costs would be saved or health outcomes improved through the use of the technology) then it may be appropriate to divert resources to alternative projects.  The earlier this is identified the better.

At this stage there is often little evidence specific to the technology.  This does not prevent the development of a value proposition as broad assumptions can be made about the performance of the technology.  It is important to be optimistic early on so assumptions about perfect test performance are not unusual.  These can be refined at later stages when more evidence is available.  It is also important to keep a wide view of how and where a technology may be used when developing a value proposition.  In the UK, NICE and the SMC focus on improvement in health and cost savings when assessing the value of medical technologies.  In other jurisdictions 'value' may be interpreted more widely and patients or clinicians may be willing to pay for a test as they value the information it provides, even if it does not directly impact on health outcomes.  During product development health economic evaluation can consider many different scenarios with the technology used in different settings, different disease areas and fitting into diagnostic pathways at different stages.  The evaluation will inform developers of how the test could most readily demonstrate value and allow, for example, specificity to be maximised if a test is to be used to ensure that only patients who were very likely to be disease positive underwent invasive diagnostic procedures.

In conclusion:

• It's never too early to start thinking about the health economics

• Developing a value proposition can help persuade funders to invest in the technology

• At concept stage - a value propositions can be narrative

• Later in the development process scenarios can be modelled in increasing detail to answer questions of interest to developers including the optimum design of the technology and the most promising jurisdictions and disease areas

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First published: 19 April 2018