How personalized medicine helps to manage a healthcare budget

This article is presenting the impact of personalized medicine on the healthcare budget. There is a significant investment by Healthcare Systems for the expensive therapy and at the same time, there is an exceptionally low response of patients on this therapy. This cost has produced a noticeably big problem to the management of the Healthcare budget. As an example, the current oncology treatments by focusing only on hospital therapy protocols without using molecular targets to guide therapy have an extremely negative impact on patients’ overall survival and on the budget in the healthcare system.

The main advantages of personalized medicine are:

• Cost saving in expensive oncology therapy in patients who are less likely to benefit

• When treatment options are limited for patients with metastatic cancer, patient screening will identify potential molecular targets. 

• Treatment suggested by molecular profiling favorably changes the clinical course for the individual patient.

Personalized medication in oncology assists oncologists with settling on proof-based treatment choices that plan to improve results and save assets. (Dean A, 2011)

The key question is: “What is the impact of personalized medicine in oncology on healthcare budget and how this could be managed differently?”

The objective is to acquire appropriate responses on “why” and “how” questions and to distinguish the most intricate issues in, particularly costly treatment to recognize the most ideal approach to help healthcare framework and financial planning.

Healthcare expenditure

Some diseases are exorbitant, both regarding patient mortality and as far as cost to society.

The Organization for Economic Co-operation and Development (OECD) estimates healthcare expenditure growing. Personalized medicine using genomic technologies allows hospitals and payers to create treatments for each individual patient, thereby reducing the costs of potentially ineffective therapies. The most important step is a diagnostic test that allows clinicians to separate responders from non-responders. (Jakka and Rossbach, 2013)

Personalized medicine in oncology enables cancer treatment selection likely response or lack of response based on molecular diagnostic testing of the tumor over a wide range of biomarker.

From a social perspective, it saves consumption on significant expense treatments in the individuals who most probably will not benefit.

Expensive drugs/treatments and the role of personalized medicine

Savage has described the numbers and therapeutic class of new oncology drugs introduced in the UK from pre-1960 to 2009.  There was significant growth in the entry of new therapeutic classes, most of which are targeted therapies, at high extremely prices.  The UK cost of treatment when using the new oncology agents is growing significantly.  (Savage P, 2012)

Effective management of the use of these expensive agents is a big concern for healthcare payers and management of the healthcare budget.

Personalized medicine assists oncologists with settling on treatment choices that intend to improve results and save assets. It will assist with keeping away from costs related to insufficient treatment.

The main goal of healthcare budget management should be to evaluate the benefits of Personalized Medicine as it addresses the best path for the treatment of patients, and it is showing a highly positive impact on the Healthcare budget.

The Concept of Personalized Medicine

The idea of personalized medicine spins around the possibility of the determination of patients who are probably going to react to the medication, so the treatment will offer better results (Soria JC, et al, 2011)

The proficiency of personalized relies upon the molecular profiling testing prior to treating, might be financially reasonable if the reserve funds acquired by keeping away from inadequate treatment and antagonistic occasions are more noteworthy than the expense of testing. (Ramsey SD, et al. 2011)

Cost-Effectiveness

The framework that balances all stakeholders (patient, hospitals, and healthcare system) without focus/implementation of personalized medicine and targeted therapy does not exist. 

Personalized medicine can fulfil its promises with better diagnoses and earlier interventions, more efficient drug development and more effective therapies only by including targeted therapy as a mandatory in the hospital protocols and the mandatory for payers (Health Insurance Funds) who would cover the molecular profiling tests’ cost (reimbursement) prior any therapy is recommended to the patients. Any expensive therapy should not be prescribed without performing the complete molecular profiling test.

Since many products include side effects, personalized treatments will minimize side effects and maximize the outcome for patients and at the same time avoid therapies that will have no effects on disease.

The market access of personalized medicine relies upon the assessment process, health technology assessment and cost of medication and reimbursement decision. To build up more innovative strategies for funding, new methodologies based on evidence development would fundamentally help in this process.

The key and most important step should be advanced molecular profiling diagnostic tests that give a prognosis for each individual patient in terms of responder or non-responder to a certain therapy.

Impact of Personalized Medicine / Targeted therapy on Healthcare budget management

Biomarkers are fundamental to distinguish responders for some treatments. Personalized medicine creates treatment strategies dependent on the molecular profiling of people and their sicknesses (Stuart Peacock, 2009)

Comprehensive Pathway Analysis would help to avoid the use of expensive therapies in patients who would not respond to that therapy.

The various biomarkers should be targeted to avoid wasted healthcare budgets and create results based on responses of average patient populations and considers effectiveness, not just efficacy (Stuart Peacock, 2009)

Conclusion

Personalized Medicine is a particular section of medicine that utilizes data about an individual’s genes, proteins, and environment to forestall, analyze, and treat disease.

The key objective of Personalized Medicine is to give the right drug to the right patient (at the right dose) and to avoid drugs from which the patient would not benefit.

The level of spending on expensive medicines has implications for healthcare systems and healthcare budget across different economies.

The new approach is showing that Personalized medicine has a positive impact on cost-effectiveness in expensive treatments and an important impact on the healthcare budget.

Personalized Medicine is a solid bridge from medical realities to tomorrow’s possibilities.

Figures 2:

Source: 2006 Deloitte Development LLC

Author: Ljiljana Lazetic

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