Personalised heart care: Worth the investment

The second of two pieces of research by Science|Business looking at the costs and benefits of a wide-scale roll out of personalised medicine has now been published in the specialist journal Health Policy and Technology.

The paper, Acute coronary syndrome: What is the cost-effectiveness of prevention, point-of-care technology and telemonitoring? concludes that healthcare costs for heart attacks would drop 46 per cent, or £2,600 per patient if this combination of techniques was applied at scale.

This reinforces the finding of an earlier paper studying the cost-effectiveness of taking a more personalised approach to breast cancer screening and care, Unlocking the value of personalised healthcare in Europe—breast cancer stratification,’ that appeared in the same journal in June. In this case, the study found the average cost per patient over 25 years could fall by 37 per cent.

Science|Business organised the breast cancer and heart attack studies as the follow-up to an initial programme of research on the subject, published in 2010, which found that despite believing in the long-term benefits, many professionals were worried that personalised healthcare will push up costs in the short term.

In the earlier research, 64 per cent of the 840 respondents to a survey carried out by researchers at the Karolinska Institutet agreed personalised healthcare would deliver improved outcomes, but said it was necessary to demonstrate cost benefits will follow on from the high up-front investment that will be required.

Health economics models

This lack of confidence that there will be cost savings in the long term has created a barrier to the deployment of personalised healthcare. The aim of the second study carried out by researchers at the Vlerick Business School was to develop health economics models to elucidate the cost-benefits of taking a more personalised approach to screening and treatment - for breast cancer in the first model - and prevention and treatment of acute cardiac syndrome (heart attack) in the second.

The Vlerick study took data from small scale trials of the new technologies in the UK, Belgium and Germany and ran them through a computer analysis of the costs and benefits, to access the outcome if such trials were to be scaled up across an entire population.

“This was the first analysis of the full ‘value chain’ of healthcare investments” from healthy individual to first diagnosis to disease treatment and on to recovery or death,” said the lead researcher, Professor Walter van Dyck of Vlerick. “It shows there’s a hefty up-front cost for these new technologies – which society may or may not want to pay. But it also shows that, in the long run, there’s also a net savings to society by keeping more people healthier for longer in their lives. That’s an important lesson in health economics.”

Prevention not mitigation

The cardiovascular study that has now been published in Health Policy and Technology focuses on disease prevention, rather than mitigation. Using data from prior studies of the effect of regular exercise, medical check-ups and tele-monitoring of at-risk individuals, the Vlerick researchers concluded that healthcare costs for heart attacks could drop 46 per cent, or £2,600 per patient – chiefly through avoiding heart attacks in the first place, and treating early problems in the GP’s office rather than in the emergency room.

In breast cancer, the study published in Health Policy and Technology in June concluded the average cost per patient over 25 years could fall by 37 per cent. The long-term savings would come from using genetic testing and patient records to screen efficiently for population groups deemed most at risk,  and then concentrating mammography, check-up and other early-detection techniques on those individuals – in essence, catching the illness earlier, when it’s easier and cheaper to treat.

But the up-front cost of computer and testing technologies, would be substantial: £2 billion in the UK alone, and it could take six to eight years for payback to show. The savings stemming from the earlier detection and a resultant drop in costly late-stage surgery and chemotherapy - is over 25 years, net of all input costs.

The Vlerick simulation was based on standard healthcare economics models, but was applied for the first time to study the beginning-to-end costs and benefits of personalised medicine technologies.

In addition to Vlerick Business school, Science|Business partners in this research were: Pfizer, Speedo, EFPIA, COST, NXP, IBM and The Royal College of Physicians.

Links:

http://www.sciencedirect.com/science/article/pii/S2211883712000445

http://www.sciencedirect.com/science/article/pii/S2211883712000585