Precision medicine is theoretically part of value-based, patient-centric care, but savings a long-way off.
Significant change is already underway with the shift to value-based care, as mandated in the 2010 US Affordable Care Act, and an increasingly prominent feature of European and other health systems. In principle, precision medicine and the technologies associated with it may ultimately help reduce costs, in part by reducing unnecessary therapy. However, in practice, those health systems embracing precision medicine today are a minority, and any savings to be gained from the wider use of molecularly-defined personalized medicine – more narrowly targeted, yet also more expensive therapies – are a long way off, if they materialize at all. “The effects of precision medicine on health care budgets is uncertain,” is how Walter Ricciardi, President of the Italian National Institute of Health, put it at the European Commission conference on Personalized Medicine in June 2016.
Among the many challenges facing molecular precision medicine is the healthcare community’s patchy understanding and use of diagnostics. Diagnostics are critical to the appropriate use of targeted medicines, yet their use is sometimes seen as an administrative burden. This is exacerbated further by a lack of regulatory and reimbursement clarity and consistency around diagnostics. Furthermore, these tests need to be highly accurate and reliable in order to be trusted, in particular to support a ‘no treatment’ decision. Achieving that accuracy is difficult. As such, given the high cost of targeted medicines and the complexities of administration, precision medicine “is probably not the solution to every healthcare problem that we have,” opines Matthias Perleth, head of the medical advice department of Germany’s Federal Joint Committee (Gemeinsamer Bundesausschuss), responsible for health care allocation and reimbursement in Germany. He was speaking at the European Commission’s Personalized Medicine conference in Brussels in June 2016.
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