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. 2018 Dec;36(12):1439-1451.
doi: 10.1007/s40273-018-0686-6.

The Future of Precision Medicine: Potential Impacts for Health Technology Assessment

James Love-Koh  1   2 , Alison Peel  3 , Juan Carlos Rejon-Parrilla  4 , Kate Ennis  3   5 , Rosemary Lovett  4 , Andrea Manca  6   7 , Anastasia Chalkidou  8 , Hannah Wood  3 , Matthew Taylor  3
Affiliations

The Future of Precision Medicine: Potential Impacts for Health Technology Assessment

James Love-Koh et al. Pharmacoeconomics. 2018 Dec.

Erratum in

Abstract

Objective: Precision medicine allows healthcare interventions to be tailored to groups of patients based on their disease susceptibility, diagnostic or prognostic information, or treatment response. We analysed what developments are expected in precision medicine over the next decade and considered the implications for health technology assessment (HTA) agencies.

Methods: We performed a pragmatic literature search to account for the large size and wide scope of the precision medicine literature. We refined and enriched these results with a series of expert interviews up to 1 h in length, including representatives from HTA agencies, research councils and researchers designed to cover a wide spectrum of precision medicine applications and research.

Results: We identified 31 relevant papers and interviewed 13 experts. We found that three types of precision medicine are expected to emerge in clinical practice: complex algorithms, digital health applications and 'omics'-based tests. These are expected to impact upon each stage of the HTA process, from scoping and modelling through to decision-making and review. The complex and uncertain treatment pathways associated with patient stratification and fast-paced technological innovation are central to these effects.

Discussion: Innovation in precision medicine promises substantial benefits but will change the way in which some health services are delivered and evaluated. The shelf life of guidance may decrease, structural uncertainty may increase and new equity considerations will emerge. As biomarker discovery accelerates and artificial intelligence-based technologies emerge, refinements to the methods and processes of evidence assessments will help to adapt and maintain the objective of investing in healthcare that is value for money.

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Conflict of interest statement

RL and JCR-P are employed by NICE and AM is a member of a NICE Technology Appraisal Committee. JL-K, AP, KE, AC, HW and MT have no potential conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Record flow diagram for pragmatic literature review. Note: Of the 525 records excluded for eligibility reasons, 382 were based on abstract and full-text review, with the remaining 143 removed due to being published prior to 2011
Fig. 2
Fig. 2
Defining precision medicine
Fig. 3
Fig. 3
Challenges for health technology assessment agencies raised by precision medicine. Note: The first-tier categories (scoping to review) relate to the four principal stages of a typical health technology assessment appraisal, such as that used by National Institute for Health and Care Excellence (NICE) in England for traditional pharmaceutical technologies [32]
See this image and copyright information in PMC

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