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Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine

Author

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  • Stuart J. Wright

    (Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, Greater Manchester, UK)

  • Mike Paulden

    (School of Public Health, University of Alberta, Edmonton, AB, Canada)

  • Katherine Payne

    (Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, Greater Manchester, UK)

Abstract

Purpose . A range of barriers may constrain the effective implementation of strategies to deliver precision medicine. If the marginal costs and consequences of precision medicine vary at different levels of implementation, then such variation will have an impact on relative cost-effectiveness. This study aimed to illustrate the importance and quantify the impact of varying marginal costs and benefits on the value of implementation for a case study in precision medicine. Methods . An existing method to calculate the value of implementation was adapted to allow marginal costs and consequences of introducing precision medicine into practice to vary across differing levels of implementation. This illustrative analysis used a case study based on a published decision-analytic model-based cost-effectiveness analysis of a 70-gene recurrence score (MammaPrint) for breast cancer. The impact of allowing for varying costs and benefits for the value of the precision medicine and of implementation strategies was illustrated graphically and numerically in both static and dynamic forms. Results . The increasing returns to scale exhibited by introducing this specific example of precision medicine mean that a minimum level of implementation (51%) is required for using the 70-gene recurrence score to be cost-effective at a defined threshold of €20,000 per quality-adjusted life year. The observed variation in net monetary benefit implies that the value of implementation strategies was dependent on the initial and ending levels of implementation in addition to the magnitude of the increase in patients receiving the 70-gene recurrence score. In dynamic models, incremental losses caused by low implementation accrue over time unless implementation is improved. Conclusions . Poor implementation of approaches to deliver precision medicine, identified to be cost-effective using decision-analytic model-based cost-effectiveness analysis, can have a significant economic impact on health systems. Developing and evaluating the economic impact of strategies to improve the implementation of precision medicine will potentially realize the more cost-effective use of health care budgets.

Suggested Citation

  • Stuart J. Wright & Mike Paulden & Katherine Payne, 2020. "Implementing Interventions with Varying Marginal Cost-Effectiveness: An Application in Precision Medicine," Medical Decision Making, , vol. 40(7), pages 924-938, October.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:7:p:924-938
    DOI: 10.1177/0272989X20954391
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    1. Bleichrodt, Han & Doctor, Jason & Stolk, Elly, 2005. "A nonparametric elicitation of the equity-efficiency trade-off in cost-utility analysis," Journal of Health Economics, Elsevier, vol. 24(4), pages 655-678, July.
    2. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    3. Adang, Eddy M.M. & Wensing, Michel, 2008. "Economic barriers to implementation of innovations in health care: Is the long run-short run efficiency discrepancy a paradox?," Health Policy, Elsevier, vol. 88(2-3), pages 236-242, December.
    4. Gijs Wetering & Willem Woertman & Eddy Adang, 2012. "Time to incorporate time in cost-effectiveness analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(3), pages 223-226, June.
    5. Richard Norman & Jane Hall & Deborah Street & Rosalie Viney, 2013. "Efficiency And Equity: A Stated Preference Approach," Health Economics, John Wiley & Sons, Ltd., vol. 22(5), pages 568-581, May.
    6. Johannesson, Magnus & Weinstein, Milton C., 1993. "On the decision rules of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 12(4), pages 459-467, December.
    7. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    8. Andrew R. Willan & Simon Eckermann, 2010. "Optimal clinical trial design using value of information methods with imperfect implementation," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 549-561, May.
    9. Gijs Wetering & Willem Woertman & Andre Verbeek & Mireille Broeders & Eddy Adang, 2013. "Quantifying short run cost-effectiveness during a gradual implementation process," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 911-918, December.
    10. Birch, Stephen & Gafni, Amiram, 1993. "Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems," Journal of Health Economics, Elsevier, vol. 12(4), pages 469-476, December.
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    1. Sean P. Gavan & Stuart J. Wright & Fiona Thistlethwaite & Katherine Payne, 2023. "Capturing the Impact of Constraints on the Cost-Effectiveness of Cell and Gene Therapies: A Systematic Review," PharmacoEconomics, Springer, vol. 41(6), pages 675-692, June.

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