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23 - Economics of personalized medicine
- from Part V - Population genetics and personalized medicine
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- By Katherine Payne, The University of Manchester, Martin Eden, The University of Manchester
- Edited by Krishnarao Appasani
- Foreword by Stephen W. Scherer, Peter M. Visscher
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- Book:
- Genome-Wide Association Studies
- Published online:
- 18 December 2015
- Print publication:
- 14 January 2016, pp 366-382
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- Chapter
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Summary
Introduction
Use of the term “personalized medicine” is now ubiquitous. However, there is little consistency in how personalized medicine is either defined or used in clinical practice. Various authors have attempted to bring together the different definitions of personalized medicine (for example: Redekop and Mladsi, 2013; Schleidgen et al., 2013). A framework has been put forward, which can be used to understand the implications of personalized medicine in terms of: the questions (e.g., what is the diagnosis?); the methods used to answer them (e.g., a test); and the available actions (e.g., to give or not give a particular drug). Alongside this proposed framework, Redekop and Mladsi offer a useful working definition of personalized medicine as: “the use of combined knowledge (genetic or otherwise) about a person to predict disease susceptibility, disease prognosis, or treatment response and thereby improve that person's health.” This is the definition adopted in this chapter, because it facilitates discussion of the broad implications when considering the economics of personalized medicine, rather than adopting the narrower focus on using genetics to target medicines.
Irrespective of how personalized medicine is defined, decision-makers charged with allocating finite healthcare budgets require robust and timely evidence to support the cost-effectiveness of technologies used to “personalize” the diagnosis, prevention, or treatment of diseases. Information on the value for money of technologies used to personalize medicine is needed before they can be recommended for funding and used in clinical practice. This chapter outlines the underlying concepts that inform the framework of economic evaluation which can be applied to provide decision-makers with the requisite information. The different types of economic evaluation are described and a summary of the current level of evidence supporting the use of a specific type of personalized medicine, using pharmaco-genetic and pharmaco-genomic technologies, is provided. An overview of the key stages in the design and conduct of an economic evaluation is presented. The chapter concludes by presenting an overview of the issues to be considered when evaluating the economic impact of technologies to personalize medicine.
Informing decision making
The existence of finite healthcare budgets and the scarcity of healthcare resources mean that there is an opportunity cost associated with every decision made to provide an intervention. The decision to allocate resources to a particular service excludes those resources from alternative possible uses within a healthcare system.
Canadian Epileptologists’ Counseling of Drivers Amidst Guideline Inconsistencies
- Jeffrey Jirsch, Donald W. Gross, Nathalie Jette, Paolo Federico, Francois Dubeau, Jose F. Tellez-Zenteno, Bernd Pohlmann-Eden, Jorge G. Burneo, Richard McLachlan, Syed N. Ahmed, Charles Deacon, Manouchehr Javidan, Dang K. Nguyen, R. Mark Sadler, Allison Spiller, Tiffany Townsend, Martin Veilleux, Richard A. Wennberg, Samuel Wiebe, Alexei Yankovsky
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 41 / Issue 4 / July 2014
- Published online by Cambridge University Press:
- 20 October 2014, pp. 413-420
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- Article
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- You have access Access
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Background:
Epilepsy is a common medical condition for which physicians perform driver fitness assessments. The Canadian Medical association (CMA) and the Canadian Council of Motor transportation administrators (CCMTA) publish documents to guide Canadian physicians’ driver fitness assessments.
Objectives:We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions.
Methods:We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians’ philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. Of the nine scenarios, CCMTA and CMA recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. Agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test.
Results:Overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). For the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). A majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. The lack of consistency in respondents’ agreement attained statistical significance (p<0.001).
Conclusions:Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. This study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada.