On cost effectiveness analysis and person-centred healthcare

Person-centred healthcare (more often referred to as personalised or precision medicine) is becoming one of the hottest topics on the public and private agenda worldwide. It has supporters among the industry, patients organisations, healthcare professionals, academics, funders and politicians. Devoting energies and resources to pursue (and hopefully realise) the promises of person-centred healthcare would seem to be a win-win strategy for a number of stakeholders. Indeed, recent years have seen an acceleration in R&D reports towards the development of novel person-centred diagnostics, drugs and medical devices (both therapeutic and support). But here lies the critical issue: how can Society shape the future of healthcare, identify and prioritise R&D investments towards acceptable, cost-effective and sustainable person-centred interventions with the highest return in terms of population health and other relevant outcomes? Cost-Effectiveness Analysis (CEA) for Health Technology Assessment (HTA) plays a pivotal role in informing such decisions in many jurisdictions around the world. However, the design and analysis of CEAs has traditionally followed the standards of mainstream clinical epidemiology and evaluation studies, reporting results based on sample means, which are expected to represent the average patient. This view of the world has been recently challenged by the need to (a) recognize individuals' heterogeneity in factors that may systematically affect costs and health outcomes, (b) reflect these characteristics in the design and analysis of CEA studies, and (c) inform more nuanced (clinical and health policy) decisions regarding funding treatments provision and further research effort priorities. This talk discusses these and a number of other issues that the current evaluative framework for healthcare decision making needs to overcome, if it is to survive the demands posed by the person-centred healthcare (r)evolution, presenting recent methodological advances that may help our pursuit of it. 

Andrea is Professor of Health Economics at the University of York and Visiting Scientist at the Luxembourg Institute of Health. His current research interests focus on the development and application of health economics methods to facilitate the evaluation of person-centred healthcare technologies. He is a member of NICE Technology Appraisal Committee and co-editor of the journal PLOS One. https://www.york.ac.uk/che/staff/research/andrea-manca/.