JAMA: Early returns since the era of precision medicine.

Recently, JAMA published an article by Dr. David M. Cutler, a professor of applied economics at Harvard University, analyzing the early returns since entering the era of precision medicine.
analysis of the early returns of the era of precision medicine, what is the result?Dr. David M. Cutler (Photo: Harvard University's official website) The era of precision medicine for cancer has arrived.
based on the results of biomarker testing, a number of precision treatment drugs were approved.
for AIDS and thrombosis and other conditions of the drug, according to the principle of drug genetics, through one or more biomarkers, tailor-made precision treatment drugs for patients.
cancer treatment drugs, has been the main focus of precision medicine.
just past 2019, the FDA approved 11 new molecular solid cancer treatments.
new molecular entity cancer treatment drugs approved by the FDA in 2019 (Source: Supplied, Group Map of The Drug Kant Content) Some cancer precision therapy drugs have been highly successful.
these drugs, imatinib had a response rate of 95 percent in patients with chronic myeloid leukemia, extending quality-adjusted life by about nine years.
the response rate of venetoclax was 80 percent in patients with 17p-demp-deficiency chronic lymphoblastic leukemia.
CAR-T drug tisagenlecleucel is used to treat acute lymphocytic leukemia with a 24-month remission rate of 62%.
Despite this, the overall therapeutic effect of precision medicine on cancer patients is not yet obvious.
2018, a study published in JAMA Oncology magazine reported that as of January 2018, only 8 percent of cancer patients would be able to use precision drugs, while in fact only 5 percent would end up benefiting.
even in patients who respond, many of the drugs increase their lifetime spending only on a monthly term.
To some extent, germany accounted for only 80 per cent of the 54 new cancer treatments listed between 2013 and 2017, compared with 69 per cent in France and 96 per cent in the US, by the end of 2018.
impact of the drug on costs Economists are not sure about the impact of precision medicine on costs.
prices tend to be higher because of the high cost of producing precision drugs.
, patients and insurance companies are willing to pay higher prices for more effective precision drugs.
, the use of precision drugs is conducive to reducing the proportion of different types of cancer patients using a variety of drugs.
, the total cost of cancer drugs has been relatively small.
while inflation-adjusted cancer drug spending increased by $30 billion between 2011 and 2018, this represented only 6 percent of the increase in total personal health care spending over the same period.
taking into account the estimated administrative costs of four times the cost of cancer drugs, the excessive attention to the cost of precision drugs should be taken with caution.
better indicator than total spending is cost-effectiveness, that is, does the benefit of treating patients with the drug exceed costs? Memorial Sloan Kettering Cancer Center has developed the "drug abacus" tool to assess the cost-benefits of 52 cancer drugs approved between 2001 and 2013.
according to the traditional method of life value assessment, only a few new drugs are worth the cost.
based on cost-benefit criteria, spending would be reduced by 30 per cent if it was priced for cancer drugs.
characteristic of individualized cancer treatment is that the use of cancer drugs appears to be largely limited to approved related adaptations.
many cancer drugs, first tested in cases of cancer metastasis that have already occurred;
in addition, the time from the start of treatment to the end of a meaningful clinical trial is shorter.
sometimes, even in the middle of a clinical trial, or before a clinical trial is completed, the use of drugs outside the label to treat early-stage cancers, or some other type of cancer.
estimates are that off-label use accounts for 30 per cent of the use of certain cancer drugs.
, however, for new therapeutic drugs, insurance companies usually require that the drug be used only by the relevant patient groups as specified when the drug is approved.
Medicare requires that there be at least one relevant outline (compendium) support for use outside the label of cancer medication.
Similarly, United Healthcare requires that medical use before cancer medications are approved, or outside the guidelines, be subject to national Comprehensive Cancer Network (NCCN) guidelines for specific reasons.
according to relevant estimates, 87% of the newly approved cancer drugs are used in less than 10,000 patients each year.
use of relevant drugs may also be limited by the complexity of the drugs themselves.
outside academic medical centers, it is not always possible to recognize that changes in new therapies and guidelines are often not quick.
diagnostic methods needed to target drug use are not available anywhere.
involve patients in decision-making can be complex.
high cost sharing can also lead to limited use.
this is a real challenge for patients who are covered by Medicare Part D (no out-of-pocket limit).
Institute for Clinical and Economic Evaluation (ICER) logo (Photo: ICER) Until recently, the pricing trend for cancer drugs has been fairly stable.
price tag for cancer drugs rose by about $8,500 a year from the mid-1990s to the mid-2010s.
however, over the past few years, there have been significant outliers.
because these individualized drugs are targeted at each specific patient, the list price of the drugs in take is higher than that of other drugs.
, the higher list price of the drug in question also reflects the higher benefits accordingly.
based on estimates from the Institute for Clinical and Economic Review, ICER, both related drugs have cost-benefits even at the above list price.
the upward trend in cancer drugs will continue, or whether the associated list price will only apply to deviations in certain circumstances.
medicine, is it worth it? The analysis shows that the impact of individual medicine on health and health spending is smaller than the strongest proponents want, or the careful actuarialists, fear.
precision medicine is a test of the healthcare system and the biomedical innovation system.
can we translate revolutionary advances in the life sciences into meaningful population health improvements at the right prices? The results of the relevant tests are very important to society.
.