Personalized medicine brings big wins to managed care

Personalized medicine can make patients healthier while lowering systemic costs. That’s according to a recent report from the Personalized Medicine Coalition (PMC), “The Personalized Medicine Report: Opportunity, Challenges, and the Future.” Personalized medicine is an evolving field in which physicians use diagnostic tests to determine which medical treatments will work best for each patient, according to the coalition. By combining the data from those tests with an individual’s medical history, circumstances and values, healthcare providers can develop targeted treatment and prevention plans. The report notes that 132 personalized medicines are available today, a 62% increase from 2012. PMC categorizes personalized medicines as therapeutic products for which the label includes reference to specific biological markers, identified by diagnostic tools, that help guide decisions and/or procedures for their use in individual patients. Pritchard“Personalized medicine aligns extremely well with managed care,” says Daryl Pritchard, PhD, vice president, science policy, PMC. “It provides high-value prevention and treatment strategies based on individual patient molecular information.” Advanced diagnostics and targeted therapies are key tools for managed care, he adds. “Therapies that are targeted for use in patient subpopulations and individuals based on their molecular characteristics improve efficacy and/or safety, thereby allowing physicians to provide the best treatment to each patient as early in their care as possible.” This in turn can bring down costs as patients avoid ineffective or harmful treatment options and downstream expenses, says Pritchard. “Furthermore, as personalized medicine is increasingly recognized as a leading paradigm in healthcare, more patients will be attracted to healthcare delivery systems that promise to practice more effective personalized care,” he says. Specific disease benefits WohlgemuthPrecision medicine is changing treatment and giving hope to people living with cancer and other diseases, says Jay G. Wohlgemuth, MD, chief medical officer and senior vice president, R&D, Quest Diagnostics. “Advances in technology and science have identified many promising opportunities to improve outcomes through insights revealed by novel diagnostic solutions,” Wohlgemuth says. According to the report, personalized medicine improves quality by: Shifting the emphasis in medicine from reaction to prevention; Directing targeted therapy and reducing trial-and-error prescribing; Reducing adverse drug reactions; Revealing additional targeted uses for medicines based on molecular pathways; Increasing patient adherence to treatment; and Reducing high-risk invasive testing procedures. Next: Cost savings analysis Cost savings “There are added costs from diagnostic testing and analysis services, but these costs should be more than offset,” says Pritchard. “Overall care costs should go down because of money saved avoiding ineffective treatments. Plus, the safety and efficacy profile of these treatments in responders is much improved.” Additionally, drugs targeted to the molecular pathway of a patient’s disease will be much more effective, leading to improved outcomes and reduced costs associated with fewer hospital visits, services and procedures, he says. Pritchard says cost savings have been demonstrated in a number of early applications of personalized medicine, for example: The use of the Oncotype DX test to predict which breast cancer patients will benefit from continued chemotherapy; The use of HER2 testing to predict which breast cancer patients will respond to the drug Herceptin; and The use of the AlloMap test to predict heart transplant rejection without the need for tissue biopsy. “These examples, and others like them, demonstrate the cost savings principal of personalized medicine, however since personalized medicine is new, for many novel technologies the cost reduction associated with downstream costs and long-term outcomes cannot yet be measured,” Pritchard says. “Many studies are being conducted to examine economic value of new technologies, but it is vital that patients have access to these technologies in order to continue to build evidence.” Growing role of data Because of significant improvements in efficiency over recent years, DNA sequencing is generating large amounts of data, covering many genes, with a single assay, says Wohlgemuth. “It also enables us to sequence a smaller number of genes very thoroughly, with very high sensitivity,” he says. “But the data generated by this technology only have value if accurately interpreted and linked to clinical decision-making.” Cognitive computing, or artificial intelligence, may play a bigger role in personalized medicine in the future, says Wohlgemuth. An example is a service, launched by Quest Diagnostics and IBM late last year, that gives U.S. physicians access to genome tumor sequencing and analysis as well as options for evidence-based cancer treatments. For a few years, major cancer centers have been using genomic tumor testing to sequence tumors, and determine which mutations link best to therapies and clinical trials, Wohlgemuth says. IBM Watson is now able to review all the world’s data around effective therapies in cancer, all the world’s data around clinical trials and cancer, and create a report to determine which therapy works best for each patient based on that patient’s tumor. Precision medicine will extend to the community, beyond academic centers, to reach the broadest number of patients who could benefit, Wohlgemuth believes. “For instance, about 70% of cancer care is delivered by community oncologists,” says Wohlgemuth “We’ve got to be able to bring advanced diagnostics to the community level. These community oncologists, however, may require different capabilities than academic centers, including with respect to genetic tests for precision medicine. In [the community oncology] setting, to provide a 300-gene panel, for example, might provide much more information than oncologists want or are willing to entertain.” Next: Trump and personalized medicine A new agenda How will personalized medicine fit into President Trump’s proposed healthcare agenda? “Congress has clearly signaled their support for the field through the passage of the 21st Century Cures Act, which includes many provisions that support and encourage the development and adoption of personalized medicine,” Pritchard says. “However the new administration’s position on personalized medicine is not clear.” Trump has stated that his goals in healthcare reform include bringing costs down while accelerating the pace of biomedical innovation, he says. Personalized medicine provides continued momentum for both goals. “If the new administration supports value-based care and patient-centered treatment strategies to help improve outcomes and drive down costs, as well as improved clinical trial design to help speed up and reduce costs of the regulatory approval of medical products, then personalized medicine will fit in very well,” says Pritchard. Tracey Walker is content manager for Managed Healthcare Executive.