Mapping the value for money of precision medicine: a systematic literature review and meta-analysis.

dc.contributor.author

Chen, Wenjia

dc.contributor.author

Wong, Nigel Chong Boon

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Wang, Yi

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Zemlyanska, Yaroslava

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Butani, Dimple

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Virabhak, Suchin

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Matchar, David Bruce

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Prapinvanich, Thittaya

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Teerawattananon, Yot

dc.date.accessioned

2024-03-25T08:16:06Z

dc.date.available

2024-03-25T08:16:06Z

dc.date.issued

2023-01

dc.description.abstract

Objective

This study aimed to quantify heterogeneity in the value for money of precision medicine (PM) by application types across contexts and conditions and to quantify sources of heterogeneity to areas of particular promises or concerns as the field of PM moves forward.

Methods

A systemic search was performed in Embase, Medline, EconLit, and CRD databases for studies published between 2011 and 2021 on cost-effectiveness analysis (CEA) of PM interventions. Based on a willingness-to-pay threshold of one-time GDP per capita of each study country, the net monetary benefit (NMB) of PM was pooled using random-effects meta-analyses. Sources of heterogeneity and study biases were examined using random-effects meta-regressions, jackknife sensitivity analysis, and the biases in economic studies checklist.

Results

Among the 275 unique CEAs of PM, publicly sponsored studies found neither genetic testing nor gene therapy cost-effective in general, which was contradictory to studies funded by commercial entities and early stage evaluations. Evidence of PM being cost-effective was concentrated in a genetic test for screening, diagnosis, or as companion diagnostics (pooled NMBs, $48,152, $8,869, $5,693, p < 0.001), in the form of multigene panel testing (pooled NMBs = $31,026, p < 0.001), which only applied to a few disease areas such as cancer and high-income countries. Incremental effectiveness was an essential value driver for varied genetic tests but not gene therapy.

Conclusion

Precision medicine's value for money across application types and contexts was difficult to conclude from published studies, which might be subject to systematic bias. The conducting and reporting of CEA of PM should be locally based and standardized for meaningful comparisons.
dc.identifier.issn

2296-2565

dc.identifier.issn

2296-2565

dc.identifier.uri

https://hdl.handle.net/10161/30380

dc.language

eng

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Frontiers Media SA

dc.relation.ispartof

Frontiers in public health

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10.3389/fpubh.2023.1151504

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Cost-Benefit Analysis

dc.subject

Precision Medicine

dc.title

Mapping the value for money of precision medicine: a systematic literature review and meta-analysis.

dc.type

Journal article

duke.contributor.orcid

Matchar, David Bruce|0000-0003-3020-2108

pubs.begin-page

1151504

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Medicine

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Pathology

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Medicine, General Internal Medicine

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University Initiatives & Academic Support Units

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University Institutes and Centers

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Duke Global Health Institute

pubs.publication-status

Published

pubs.volume

11

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