Can Genomic Medicine Improve Financial Sustainability of Health Systems?
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CURRENT OPINION
Can Genomic Medicine Improve Financial Sustainability of Health Systems? Christine Y. Lu1 • Joshua P. Cohen2
Springer International Publishing Switzerland 2015
Abstract Recent years have seen increased use of genomic technologies in a variety of research and clinical settings. Genomic medicine is not a cost-containment measure per se, but is viewed as having the potential to bend the healthcare cost curve. Currently, it is unknown how systematic adoption of genomic medicine in clinical practice will impact healthcare costs. This article discusses the potential economic impact of genomic medicine and the challenges that lie ahead.
Key Points The value of genomic technologies may be grouped into two levels: health benefits to patients and savings to the health system, and benefits beyond health gains to patients and to the society. In the context of financial sustainability of health systems, it is important to consider the impact of using genomic technologies on the health budget, i.e. use of related services, such as interpretation, and downstream benefits, consequences, and costs of services in the care pathways, which are likely to be more costly than the upfront cost of genomic technologies. Given the uncertainty due to evidence and knowledge gaps as well as challenges in the current regulatory framework and information infrastructure that must be overcome, it remains to be seen whether or not widespread use of genomic technologies will improve financial sustainability of health systems.
1 Introduction & Christine Y. Lu [email protected] 1
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 6th Floor, 133 Brookline Ave, Boston, MA 02215, USA
2
Tufts Center for the Study of Drug Development/Department of Public Health and Community Medicine, Boston, MA, USA
Health spending, accounting for 9.3 % of gross domestic product on average across industrialized countries in 2012, has started to rise again after stagnating in many industrialized countries during the economic crisis, although growth remains well below pre-crisis rates [1]. Policymakers are paying considerable attention to cost-containment approaches to attain financial sustainability of health systems [2]. Policies include generic substitution, tiered
C. Y. Lu, J. P. Cohen
medicines co-developed with companion diagnostics in recent years, including ivacaftor prescribed to cystic fibrosis patients with the R117H mutation, vemurafenib for melanoma patients with the BRAF V600E mutation, and crizotinib for non-small cell lung cancer patients who are anaplastic lymphoma kinase (ALK) positive. There are now more than 150 FDA-approved drugs that include pharmacogenomic information in their labeling [8, 9]. Furthermore, next-generation sequencing technologies have ushered in the capability to assess disease risks. Increasingly, gene panel testing is available to assess multiple genes in parallel, for example to assess for genetic alterations that may contribute to inherited
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