The Economics of Genomic Medicine Workshop Summary (2013) / Chapter Skim
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3 The Intersection of Genomics and Health Economics
3 The Intersection of Genomics and Health Economics
Pages 15-22
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From page 15... ...
• Patient and provider responses to genome sequencing will require new investments in services, new pathways of care, genetic counseling, decisions about what will and will not be covered by insurance, and provisions for dealing with inciden tal findings. • Quicker approaches that incorporate qualitative assessments need to be devised for the economic evaluation of genetic information.
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ECONOMIC EVALUATION TOOLS Economists use several different tools to carry out economic evaluations of health care interventions, including cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis (CEA) , and cost-utility analysis (CUA)
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From page 17... ...
Strengths Weaknesses Cost-minimization Yes Not necessary Easy to Useful only if perform outcomes are the same for both interventions Cost-benefit Yes Yes, in Good Less commonly monetary theoretical accepted by terms foundation; health care can be decision makers; used within evaluation health care of benefits and across methodologically sectors of the challenging economy Cost-effectiveness Yes Yes, in clinical Relevant for Cannot compare terms (events, clinicians; interventions life years) easily across disease understandable areas when using disease-specific end points Cost-utility Yes Yes, in quality- Incorporates Requires adjusted life quality of life; evaluation years comparable of patient across disease preferences; can areas and be difficult to interventions; interpret standard SOURCE: David Veenstra, IOM workshop presentation, July 17–18, 2012.
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The worst is when outcomes become worse and costs increase. Most interventions in health care result in higher costs with improved outcomes, Veenstra said, which makes CUAs useful for comparing these interventions.
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SOURCE: David Veenstra, IOM workshop presentation, July 17–18, 2012. terms of base pairs sequenced per dollar, the number of clinically meaningful genetic variants identified, diagnoses received, clinical actions taken, or patient outcomes.
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According to Veenstra, comparative-effectiveness research includes all of the following components: • Stakeholder-informed prioritization and design of studies • Direct, head-to-head comparisons • A broad range of beneficiaries, including patients, clinicians, pur chasers, and policy makers
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A related policy issue involves evidence thresholds. Does a lower cost of obtaining information lead to a lower evidence threshold for using that information?
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From page 22... ...
The third and final challenge Veenstra described is the impact of whole genome sequencing on the health care system. We do not know how patients and providers will respond to the information available from genomic tests, specifically as it impacts their decisions about receiving medical care.
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