Personalised medicine appears to be an inevitable future of health care, and economists aren’t ready for it.
It has various monikers and related concepts including precision medicine, stratified medicine, pharmacogenomics, pharmacogenetics and predictive medicine. But, whatever you call it, it means big changes in health care. Sociologists, ethicists, medics and others have all been confronting it in recent years. Economists have been relatively slow on the uptake, though some have begun thinking about it (see for example here, here, here)
Some of my current work involves evaluating predictive medicine in the form of a screening intervention, and we have a paper in the pipeline discussing some of the implications for cost-effectiveness analysis. This work is presenting a number of new challenges but is also highlighting some opportunities for the optimisation of health care.
Over the next few months I will be introducing and discussing some of the potential implications of personalised medicine for our discipline. These will include familiar topics in health economics and will probably fall under the following headings:
- Demand for health and health care
- Supply of health care
- Provider behaviour
- Health insurance
- Economic evaluation
- Decision modelling
- Population health
- New market failures
These may merge, change or disappear as I progress, but I hope to cover as many angles as possible. Hopefully, with your feedback, we might be able to help guide future work in this area.
See chapter 25 of Statistical Issues in Drug Development http://www.senns.demon.co.uk/SIDD.html for a partly sceptical view of the challenges in trial design alone for personalising medicine. See also chapter 24 for a review of Kwerel’s neglected economics paper on the subject.
One of the problems is that intra-subject variability has been ignored as a possible explanation of variability in observed response to treatment.