Affiliations 

  • 1 Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, USA, ssnyder@gsu.edu
  • 2 Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, USA
  • 3 Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA
  • 4 Department of Pharmacology, University of Malaya, Kuala Lumpur, Malaysia
  • 5 School of Pharmacy, Monash University Sunway Campus, Subang Jaya, Malaysia
  • 6 Department of Social and Preventive Medicine, Julius Centre, University of Malaya, Kuala Lumpur, Malaysia
  • 7 Department of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
  • 8 University of Patras School of Health Sciences Department of Pharmacy, Patras, Greece
  • 9 The Golden Helix Foundation, London, United Kingdom
  • 10 Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
Public Health Genomics, 2018;21(5-6):217-227.
PMID: 31189173 DOI: 10.1159/000500725

Abstract

BACKGROUND/AIMS: Economic evaluation is integral to informed public health decision-making in the rapidly growing field of precision and personalized medicine (PM); however, this research requires specialized expertise and significant resources. Generic models are a novel innovation to efficiently address a critical PM evidence shortage and implementation barrier by enabling use of population-specific input values. This is a generic PM economic evaluation model proof-of-concept study for a pharmacogenomic use case.

METHODS: An 8-step generic economic model development process was applied to the use case of human leukocyte antigen (HLA)-B*15:02genotyping for prediction of carbamazepine-induced cutaneous reactions, with a user-friendly decision-making tool relying on user-provided input values. This generic model was transparently documented and validated, including cross-validation comparing cost-effectiveness results with 3 country-specific models.

RESULTS: A generic pharmacogenomic use case cost-effectiveness model with decision-making tool was successfully developed and cross-validated using input values for 6 populations which produced consistent results for HLA-B*15:02 screening at country-specific cost-effectiveness threshold values. Differences between the generic and country-specific model results were largely due to differences in model structure and assumptions.

CONCLUSION: This proof on concept demonstrates the feasibility of generic models to provide useful PM economic evidence, supporting their use as a pragmatic and timely approach to address a growing need.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.