Impact of Personalized Medicine on the Cost-Effectiveness of Prevention

描述（由申请人提供）：基于个人特定信息（包括家族史和基因组学）的量身定制的卫生保健干预措施有望在不久的将来改变临床实践。以预防疾病为目标的个性化医疗前景广阔，因为它可以减少对高成本治疗的需求，并改善国民的整体健康状况。因此，迫切需要评估个性化医疗对健康结果和成本的预期影响。我们建议建立一个数学模型，以确定这些预防性检测的潜在影响，并评估这些检测可能采用的阈值灵敏度、特异性和成本，这将非常有利于将该领域推向更大的临床应用。个性化医疗的发展更加重视个人层面的决策，这需要使用微模拟技术的下一代建模。因此，我们建议使用基于主体的模型（ABM）来研究个性化医疗对预防成本效益的影响，以模拟个体行为和相互作用，并评估它们在人群水平上的集体影响。我们将建立一个结肠直肠癌（CRC）预防和筛查的原型模型，以证明该建模方法的实用性和可行性。本研究的具体目的如下：开发一个执行微观模拟建模的框架，以评估个性化医疗和基因组学对预防成本和收益的影响。具体目标2。创建CRC预防的原型模型，以证明开发ABM以评估个体水平差异的可行性。具体目标3。确定个体化方法（包括基因检测）预防结直肠癌可能节省成本或具有成本效益的阈值。这项研究的总体目标是提供一个框架，可以促进使用ABMs来研究个性化医疗对预防广泛疾病的成本效益的影响，包括其他癌症、糖尿病、心脏病和肥胖。

DESCRIPTION (provided by applicant): Tailored health care interventions based on information specific to an individual, including family history and genomics, are expected to transform clinical practice in the near future. Personalized medicine targeted at preventing diseases holds great promise because it can reduce the need for high-cost treatments and improve the overall health of the nation. Therefore, there is an imminent need to assess the projected impact of personalized medicine on both health outcomes and cost. We are proposing to develop a mathematical model for identifying the potential impacts of these preventive tests and to assess the threshold sensitivity, specificity, and cost under which these tests are likely to be adopted, which will be extremely beneficial in moving this field forward toward greater clinical application. The movement toward personalized medicine, which places greater importance on personal-level decision making, requires next-generation modeling using micro simulation techniques. Therefore, we are proposing to study the impact of personalized medicine on the cost-effectiveness of prevention using an agent-based model (ABM) to simulate individual behaviors and interactions and to assess their collective impacts at the population level. We will build a prototype model for colorectal cancer (CRC) prevention and screening to demonstrate the utility and feasibility of this modeling approach. The specific aims of this research are as follows: Specific Aim 1. Develop a framework for performing micro simulation modeling to assess the impact of personalized medicine and genomics on the costs and benefits of prevention. Specific Aim 2. Create a prototype model for CRC prevention to demonstrate the feasibility of developing an ABM to assess individual-level differences. Specific Aim 3. Identify the thresholds under which personalized approaches, including genetic testing, for CRC prevention could potentially be cost-saving or cost-effective. The overall goal of this research is to provide a framework that can foster the use of ABMs to study the impact of personalized medicine on the cost-effectiveness of prevention for a wide range of diseases, including other cancers, diabetes, heart disease, and obesity. PUBLIC HEALTH RELEVANCE: Personalized medicine targeted at preventing diseases holds great promise because it can reduce the need for high-cost treatments and improve the overall health of the nation. Developing a mathematical model to identify the potential impacts of these preventive tests and assessing the threshold sensitivity, specificity, and cost under which these tests are likely to be adopted will be extremely beneficial in moving this field forward toward greater clinical application. We will build a prototype model for colorectal cancer prevention and screening to demonstrate the utility and feasibility of this modeling approach.