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, Sir William Duncan Building (Level 7), 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 (RC) 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, 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, Modelling (i.e., “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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