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Is Individualized Medicine More Cost-Effective? A Systematic Review

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Abstract

Background

Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence.

Objective

Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness.

Data sources

A literature search of MEDLINE database for English- and German-language studies was conducted.

Study appraisal and synthesis method

Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results.

Results

Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant.

Limitations

Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency.

Conclusions

IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than ‘whether’ healthcare was individualized, the question of ‘how’ it was individualized was of economic relevance.

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Acknowledgments

The authors are grateful to Matthias Hunger for statistical advice. This research is carried out on behalf of the Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH). This research center is an independent organization funded by the German and Bavarian Government.

Author contributions

MH and WR are responsible for the conception and design of the study. The literature search and the data extraction were conducted by MH and KS. Studies were selected by MH, KS, and WR. The manuscript was drafted and improved by MH and WR. Overall guarantor for the content of this paper is MH. None of the authors have a conflict of interest with regard to this project.

Grant support

This study received support from a grant funded by the German Federal Ministry of Education and Research (BMBF) within the context of the “ethical, legal and social aspects of modern life sciences and biotechnology” ELSA-project (Grant Number 01GP1006A-C).

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Authors and Affiliations

  1. Hamburg Center for Health Economics, University of Hamburg, 20354, Hamburg, Germany

    Maximilian H. M. Hatz

  2. Institute for Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health, 85764, Neuherberg, Germany

    Maximilian H. M. Hatz, Katharina Schremser & Wolf H. Rogowski

  3. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilians University, 80336, Munich, Germany

    Wolf H. Rogowski

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Hatz, M.H.M., Schremser, K. & Rogowski, W.H. Is Individualized Medicine More Cost-Effective? A Systematic Review. PharmacoEconomics 32, 443–455 (2014). https://doi.org/10.1007/s40273-014-0143-0

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