Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, Greater Manchester, UK.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Med Decis Making. 2020 Oct;40(7):924-938. doi: 10.1177/0272989X20954391.
. A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness. This study aimed to illustrate the importance and quantify the impact of varying marginal costs and benefits on the value of implementation for a case study in precision medicine. . An existing method to calculate the value of implementation was adapted to allow marginal costs and consequences of introducing precision medicine into practice to vary across differing levels of implementation. This illustrative analysis used a case study based on a published decision-analytic model-based cost-effectiveness analysis of a 70-gene recurrence score (MammaPrint) for breast cancer. The impact of allowing for varying costs and benefits for the value of the precision medicine and of implementation strategies was illustrated graphically and numerically in both static and dynamic forms. . The increasing returns to scale exhibited by introducing this specific example of precision medicine mean that a minimum level of implementation (51%) is required for using the 70-gene recurrence score to be cost-effective at a defined threshold of €20,000 per quality-adjusted life year. The observed variation in net monetary benefit implies that the value of implementation strategies was dependent on the initial and ending levels of implementation in addition to the magnitude of the increase in patients receiving the 70-gene recurrence score. In dynamic models, incremental losses caused by low implementation accrue over time unless implementation is improved. . Poor implementation of approaches to deliver precision medicine, identified to be cost-effective using decision-analytic model-based cost-effectiveness analysis, can have a significant economic impact on health systems. Developing and evaluating the economic impact of strategies to improve the implementation of precision medicine will potentially realize the more cost-effective use of health care budgets.
一系列障碍可能会限制精准医学策略的有效实施。如果精准医学的边际成本和后果在不同的实施水平上有所不同，那么这种差异将对相对成本效益产生影响。本研究旨在说明边际成本和收益变化对精准医学实施价值的重要性，并定量评估其影响。本研究改编了一种现有的计算实施价值的方法，以允许将精准医学引入实践的边际成本和后果在不同的实施水平上有所不同。本案例研究采用了一种已发表的基于决策分析模型的成本效益分析方法，对乳腺癌的 70 基因复发评分（MammaPrint）进行了分析。通过图形和数值方式，以静态和动态形式说明了允许实施价值和实施策略的边际成本和收益变化对精准医学的影响。引入这种特定的精准医学实例所表现出的规模报酬递增意味着，要使 70 基因复发评分在 20,000 欧元/质量调整生命年的既定阈值下具有成本效益，至少需要达到 51%的实施水平。观察到的净货币收益的变化意味着实施策略的价值不仅取决于初始和最终的实施水平，还取决于接受 70 基因复发评分的患者数量的增加幅度。在动态模型中，除非实施情况得到改善，否则低水平实施所造成的增量损失会随着时间的推移而累积。未能有效地实施能够通过决策分析模型-based 成本效益分析被认定为具有成本效益的精准医学方法，可能会对卫生系统产生重大的经济影响。开发和评估改善精准医学实施的经济影响的策略，有可能实现更具成本效益的医疗保健预算利用。
