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Systematic Review Of Economic Evaluations In Personalized Medicine

      Objectives

      Personalized medicine (PM) consists of a customized approach considering individual biological and genetic characteristics to prevent, diagnose or treat a medical condition. Although health benefits of PM have been demonstrated, its economic impact is not established. The aim of this review was to explore its cost-effectiveness and summarize the key parameters in every therapeutically health areas.

      Methods

      A systematic review of economic evaluations was performed using the PICO method. Population consisted of patients who might benefit from PM; intervention and comparators were PM and usual care and outcomes were results of economic evaluations. The literature search was performed with the NHS EED filters using Medline, Embase and Pubmed from 2004 to 2014. Eligible articles were economic evaluations, with preventive, diagnostic or therapeutic interventions in PM.

      Results

      A total of 76,488 studies were identified and 213 met the inclusion criteria. Cost-utility studies were the most frequent (60.1%), followed by cost-effectiveness studies (32.1%) with a healthcare-payer perspective (67.9%). Time horizon varied between 28 days and lifetime. Cancer was the most evaluated therapeutic field (46.9%) followed by cardiovascular diseases (19.2%) and neurologic and psychological diseases (10.3%). A total of 39.9% of the studies were conducted in the United States. Adjusted 2015USD ICERs varied from dominant to $9,780759 per quality adjusted life year (QALY). Among these, 44% have an ICER of $50,000/QALY or less, while 57% have an ICER of $100,000/QALY or less. Overall, a total of 147 studies compared their ICER to the reference threshold established by their country. Among the ICERs presented, 60.2% were reported as cost-effective (15.3% were dominant) and 39.8% non cost-effective.

      Conclusions

      Despite a high heterogeneity among the studies, most of them suggest that personalized medicine could be cost-effective.