The Future of Precision Medicine: Potential Impacts for Health Technology Assessment.
The Future of Precision Medicine: Potential Impacts for Health Technology Assessment.
复制标题
DOI：
10.1007/s40273-018-0686-6
复制
发表时间：
2018-12
影响因子：
4.4
通讯作者：
Taylor M
中科院分区：
文献类型：
--
作者：
Love-Koh J;Peel A;Rejon-Parrilla JC;Ennis K;Lovett R;Manca A;Chalkidou A;Wood H;Taylor M
精准医疗允许根据患者群体的疾病易感性、诊断或预后信息或治疗反应来定制医疗保健干预措施。我们分析了未来十年精准医疗的预期发展，并考虑了对卫生技术评估 (HTA) 机构的影响。我们进行了务实的文献检索，以考虑精准医学文献的规模大和范围广。我们通过一系列长达 1 小时的专家访谈来完善和丰富这些结果，其中包括来自 HTA 机构、研究委员会和研究人员的代表，旨在涵盖广泛的精准医学应用和研究。我们确定了 31 篇相关论文并采访了 13 名专家。我们发现临床实践中预计会出现三种类型的精准医疗：复杂算法、数字健康应用和基于“组学”的测试。这些预计将影响 HTA 流程的每个阶段，从范围界定和建模到决策和审查。与患者分层和快节奏的技术创新相关的复杂且不确定的治疗途径是这些影响的核心。精准医疗的创新带来了巨大的好处，但也将改变一些医疗服务的提供和评估方式。指导意见的有效期可能会缩短，结构性不确定性可能会增加，并且新的股权考虑因素将会出现。随着生物标志物发现的加速和基于人工智能的技术的出现，证据评估方法和流程的改进将有助于适应和维持物有所值的医疗保健投资目标。本文的在线版本 (10.1007/s40273-018-0686-6) 包含补充材料，可供授权用户使用。
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. 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. 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. 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. The online version of this article (10.1007/s40273-018-0686-6) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
3.5
作者：
Brouwer, Werner B. F.;Culyer, Anthony J.;Rutten, Frans F. H.
通讯作者：
Rutten, Frans F. H.
影响因子：
11.5
作者：
Byron, Sarah K.;Crabb, Nick;Newland, Adrian
通讯作者：
Newland, Adrian
影响因子：
3.6
作者：
Epstein, David;Garcia Mochon, Leticia;Soares, Marta O.
通讯作者：
Soares, Marta O.
影响因子：
2.1
作者：
Buchanan, James;Wordsworth, Sarah;Schuh, Anna
通讯作者：
Schuh, Anna
影响因子：
4.5
作者：
Annemans, Lieven;Redekop, Ken;Payne, Katherine
通讯作者：
Payne, Katherine