Development of the PICCOTEAM Reference Case for Economic Evaluation of Precision Medicine

Document Type : Original Article

Authors

1 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

2 Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand

3 Centre for Healthcare Equipment and Technology Adoption, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK

4 Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK

5 Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia

6 Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia

7 Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands

8 Department of Management Science, University of Strathclyde Business School, Glasgow, UK

9 Duke-NUS Medical School, Singapore, Singapore

10 Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore

11 Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

12 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

13 Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand

14 Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

15 A full list of collaborators of the Working Group is provided in Supplementary file 1

Abstract

Background 
Current economic evaluations (EEs) of precision medicine (PM) often adhere to generic reference cases (RCs) which overlook the unique healthcare paradigms of PM. This study aimed to develop an RC to standardize the conduct and reporting of EEs of PM.
 
Methods 
A working group comprising 5 core health economists, 22 PM experts, and research staff from Singapore, Thailand, the Netherlands, UK, and Australia who were actively engaged in EE and clinical PM implementation. The RC development comprised four stages: (1) Expert consultation shaping the RC’s scope and structure across nine domains: Population, Intervention, Comparator, Cost, Outcome, Time, Equity and ethics, Adaptability, and Modelling (ie, “PICCOTEAM” framework); (2) A comprehensive literature review on current PM EE approaches and challenges; (3) Obtaining expert consensus and drafting recommendations; (4) A workshop for RC refinement based on stakeholder feedback on relevance and feasibility. Following an experts’ workshop, consensus was reached to tailor PM recommendations for screening, diagnosis, and pharmacogenomics, market-access, and early EEs.
 
Results 
The PICCOTEAM RC offers 46 recommendations for conventional EEs to guide PM reimbursement, emphasizing expert engagement, iterative study processes, disease-specific outcomes, decision uncertainty analyses, and equity considerations. Additionally, 30 recommendations are provided for early-stage evaluation to enhance PM’s positioning and value proposition, mitigating uncertainty, equity, and ethical issues.
 
Conclusion 
The PICCOTEAM RC offers a standardized process to conduct and report diverse PM EEs. This will serve as guidance for health departments, researchers, clinicians, editors, and reviewers. Pilot testing and continuous updates are recommended for ongoing relevance and applicability of this RC. 

Keywords

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History

  • Received Date: 13 August 2024
  • Revised Date: 16 April 2025
  • Accepted Date: 02 August 2025
  • First Published Date: 04 August 2025
  • Published Date: 01 December 2025

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