Recorded at the Centre for Personalised Medicine’s ‘Personalised Medicine and Resource Allocation’ conference, this talk takes a look at decisions that need to be made about which tests should be funded by public health care payers, exploring the topic of priority setting for genetic tests. Wolf Rogowski is a health economist at the Helmholtz Center Munich, Institute of Health Economics and Health Care Management in Germany. Since August 2009, he has been head of the institute’s research unit “Translational Health Economics”. He holds a Ph.D. from Ludwig-Maximilians Universität in Munich and has held visiting fellowships at the Centre of Health Economics at the University of York (UK), the Hastings Center in Garrison, New York (USA) and the Harvard School of Public Health, Boston (USA). Focusing on genetic testing and personalized medicine, Wolf serves as a member of the European Society for Human Genetics’ Professional and Public Policy Committee and the scientific advisory board of the Journal of Community Genetics. Wolf explores the process of translational medicine from a health economics perspective. This includes: the application of cost-effectiveness and value of information analysis to new health technologies; the empirical and theoretical assessment of methods and procedures applied in decision making; and the development of instruments for decision support. He has a particular interest in the intersection of ethics and economics in medical innovation.

This presentation discusses the role of health economics, focusing on both the methodological and political opportunities and challenges and how these may vary across countries. Kathryn A. Phillips is Professor of Health Economics and Health Services Research and Founding Director of the UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS). Kathryn focuses on the translation of new technologies into improved patient outcomes and its impact on clinical care, health economics, and health policy. Her core specialty is personalized (or precision) medicine. Kathryn’s work spans multiple disciplines, including basic, clinical and social sciences, and brings together leading experts in academia, industry, healthcare, payers, and government.

This presentation introduces the ethical issues and governance challenges presented by large scale genomics research projects using the 100,000 Genomes Project as a case study. it goes on to suggest that these new forms of research present an important challenge in the way in which we understand autonomy and paternalism in research. Mike Parker is Professor of Bioethics and Director of the Ethox Centre at the University of Oxford. One of his main research interests is in the ethical aspects of the clinical use of genetics. He is a member of the Nuffield Council of Bioethics Working Group on the collection, linking, use and exploitation of biological and health data, the Data Access Committee of the Wellcome Trust Case-Control Consortium, and the Medical Research Council’s Ethics, Regulation and Public Involvement Committee. Professor Parker also chairs Genomics England’s ethics committee as well as being an ethics consultant to UK Biobank. He has previously been a member of a number of national and international committees and working parties including the Ethics in Practice Committee of the Royal College of Physicians and the Department of Health’s Committee for the Ethical Aspects of Pandemic Influenza.

As with other areas of personalised medicine, diagnostic testing costs are of concern, although improved embryo selection leads to the reduction in future costs and the need for future interventions. This presentation describes a recent cost-effectiveness analysis applied to a theoretical embryo diagnostic procedure and its influence on the cost per live birth. This case study is used to illustrate unique features of cost-effectiveness analysis of personalised medicine in reproductive healthcare and influence on resource allocation.

In this presentation, early health economic modelling is introduced to estimate the potential health impact of implementing CTC diagnostic technologies – with a focus on the potential health impact of using CTCtrap in breast and prostate cancer. Maarten IJzerman is professor of clinical Epidemiology & HTA and chair of the department Health Technology & Services Research at the University of Twente, the Netherlands. In 2013 and 2014 he has been the acting Scientific Director of MIRA, Institute for Biomedical Technology and Technical Medicine. Maarten received his MSc in 1993 in Biomedical Health Science at the University of Nijmegen and a PhD in Biomedical Engineering at the University of Twente in 1997. Maarten and his team work on methods to evaluate the benefits of diagnostic and imaging technologies and on the application of outcomes research and decision analytic models to predict health economic impact of medical technologies in development. The early assessment research program intends to further enhance the revenues of public and private spending in biomedical research. An important methodological contribution is made in the use of multi-criteria decision models to elicit stakeholder- and patient preferences for health outcomes and technology. He has more than 130 peer-reviewed articles in the intersection of engineering, medicine and outcomes research. Maarten is a visiting adjunct professor at Case Western Reserve University in Cleveland (USA) and serves on numerous national and international boards and scientific committees. He is a member of the ISPOR board of directors and is a member of the ISPOR Health Science Policy Council. He is chair of the Committee for revising the Dutch Pharmacoeconomic guidelines (ZINL) and co-chair of the ISPOR taskforce Multi-Criteria Decision Analysis (MCDA). He is a member of the ISPOR taskforces on Simulation Modeling and Statistical Analysis of Conjoint studies. Since 2013, he initiated GITHE (Global Initiative for Translational Health Economics). A joint collaboration between the MIRA Research Institute of the University of Twente (the Netherlands), Antoni van Leeuwenhoek Hospital – Netherlands Cancer Institute (The Netherlands), the Fred Hutchinson Cancer Research Center in Seattle (USA), the University of York (UK), UMIT in Hall (Austria) and CRP-Santé and EPEMED (both based in Luxembourg). Originating from their research program, Maarten IJzerman initiated the University spin-off company PANAXEA b.v. in 2010.

Talk recorded at the Centre for Personalised Medicine’s ‘Personalised Medicine & Resource Allocation’ conference. Whole-body CT scans and whole genome sequencing share a similar concept of examining virtually any part of the body to detect a tumour or other abnormality, or predict disease risk. The presentation identifies several approaches used in economic evaluations of whole-body CT scans that may help to refine methodological approaches to conducting economic evaluation of whole genome sequencing.

This presentation considers the methodological challenges associated with conducting economic evaluations in genomics. The issues fall into several categories including choosing an appropriate analytical approach, and the challenges associated with measuring costs, outcomes and effectiveness. James Buchanan joined the Health Economics Research Centre in September 2005, having completed his MA in Economic Development and Policy Analysis and his BA in Economics at the University of Nottingham. James is currently undertaking a DPhil (PhD) investigating issues related to the economic analysis of genomic diagnostic technologies for multifactorial genetic diseases in the UK NHS, based on a study evaluating targeted next generation sequencing in chronic lymphocytic leukaemia. Previous genetics projects have included the development of an economic modelling framework to evaluate novel genomic diagnostic tools in inflammatory bowel disease, a cost-effectiveness analysis of microarray technology in the NHS, and an economic evaluation of the use of genetic testing to identify gastrointestinal pathogens to improve hospital infection control practice. Jilles Fermont is a researcher at the Health Economic Research Centre, University of Oxford. Jilles primarily works on projects addressing the economics of genetic and genomic technologies such as high-throughput next-generation sequencing in cancer research and whole-genome sequencing in mycobacteria and humans for individual patient care. His research is funded from several sources such as the Health Innovation Challenge Fund and the Technology Strategy Board. In addition, Jilles is an honorary NHS researcher at the Oxford Molecular Diagnostics Centre. His research interests include economic evaluations, clinical trials, discrete choice experiments, cancer research, translational research, and genetic and genomic technologies.

Professor Frances Flinter is a Consultant Clinical Geneticist and the Caldicott Guardian at Guy’s & St Thomas NHS Foundation Trust. She has a personal chair in Clinical Genetics at King’s College, London. In addition Frances is Chair of the Medical Genetics Clinical Reference Group, which is responsible for developing the national specialised service level strategy together with service specifications and policies for NHS clinical and laboratory Medical Genetics services in England. Economic evaluation of the entire patient pathway is required before the potential contribution of genetic testing can be properly assessed and there are many examples where the carefully targeted use of genetic testing can actually save the NHS money, as well as enhancing patient care by reducing the time it takes to make a diagnosis, enabling cascade testing to relevant family members and, in some cases, enabling truly personalised, precision medicine.

Personalised medicine can raise practical and ethical dilemmas. This presentation argues that there is one form of personalised medicine – risk-based screening – that can be practically and ethically implemented. It also discusses implications and applications for genomic medicine and individualised cost-effectiveness analysis more broadly.

Type-2 diabetes is a complex disease with multiple risk factors and health consequences. This talk presents a microsimulation model which has been developed to evaluate the effectiveness and cost-effectiveness of diabetes prevention interventions, both in the general population or in sub-groups at high risk of diabetes in the UK. The results have implications for the allocation of public health resources between different subgroups at risk of type-2 diabetes, and demonstrate the ability of the model to estimate the benefits of flexibly specified interventions for highly specific population subgroups.