Generic Cost-Effectiveness Models: A Proof of Concept of a Tool for Informed Decision-Making for Public Health Precision Medicine

• Main Authors: Snyder, Susan R., Hao, Jing, Cavallari, Larisa H., Geng, Zhi, Elsey, Amanda, Johnson, Julie A., Mohamed, Zahurin, Chaiyakunapruk, Nathorn, Chong, Huey Yi, Dahlui, Maznah, Shabaruddin, Fatiha Hana, Patrinos, George P., Mitropoulou, Christina, Williams, Marc S.
• Format: Article
• Published: Karger Publishers 2019
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/23410/; https://doi.org/10.1159/000500725

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. © 2019 S. Karger AG, Basel. All rights reserved.