Issues surrounding the health economic evaluation of genomic technologies
Issues surrounding the health economic evaluation of genomic technologies
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DOI：
10.2217/pgs.13.183
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发表时间：
2013-11-01
期刊：
影响因子：
2.1
通讯作者：
Schuh, Anna
中科院分区：
文献类型：
--
作者：
Buchanan, James;Wordsworth, Sarah;Schuh, Anna
目的：基因组干预可以改善疾病分层和个体化治疗。然而，由于缺乏证据，特别是经济证据，迄今为止它们对临床实践的影响有限。部分原因是健康经济学家尚未就现有方法是否足以评估基因组技术达成共识。由于不同的方法可能会产生相互冲突的采用决策，因此迫切需要澄清。本文总结了与对基因组干预进行经济评估相关的方法学问题。材料和方法：进行了结构化文献综述，以确定在对基因组干预进行经济评估时考虑到的方法学挑战的参考文献。结果：与分析方法相关的方法学挑战包括比较器、视角和时间框架的选择。成本核算的挑战集中在需要在数据有限的环境中经常收集广泛的成本。衡量结果是有问题的，因为标准措施的适用性有限，然而，替代指标（例如个人效用）尚未开发，替代方法（例如成本效益分析）未得到充分利用。有效性数据质量很弱，难以纳入标准经济分析，而在这方面，人们对患者和临床医生的行为知之甚少。信息分析的综合价值可能会有所帮助。结论：基因组技术的经济评估对健康经济学家提出了特殊的挑战。可能需要新的方法来解决这些问题，但尚未提供替代方法的证据。这应该是该领域未来工作的重点。原件于 2013 年 7 月 30 日提交； 2013 年 9 月 12 日提交修订
Aim: Genomic interventions could enable improved disease stratification and individually tailored therapies. However, they have had a limited impact on clinical practice to date due to a lack of evidence, particularly economic evidence. This is partly because health economists are yet to reach consensus on whether existing methods are sufficient to evaluate genomic technologies. As different approaches may produce conflicting adoption decisions, clarification is urgently required. This article summarizes the methodological issues associated with conducting economic evaluations of genomic interventions. Materials & methods: A structured literature review was conducted to identify references that considered the methodological challenges faced when conducting economic evaluations of genomic interventions. Results: Methodological challenges related to the analytical approach included the choice of comparator, perspective and timeframe. Challenges in costing centered around the need to collect a broad range of costs, frequently, in a data-limited environment. Measuring outcomes is problematic as standard measures have limited applicability, however, alternative metrics (e.g., personal utility) are underdeveloped and alternative approaches (e.g., cost-benefit analysis) underused. Effectiveness data quality is weak and challenging to incorporate into standard economic analyses, while little is known about patient and clinician behavior in this context. Comprehensive value of information analyses are likely to be helpful. Conclusion: Economic evaluations of genomic technologies present a particular challenge for health economists. New methods may be required to resolve these issues, but the evidence to justify alternative approaches is yet to be produced. This should be the focus of future work in this field. Original submitted 30 July 2013; Revision submitted 12 September 2013