Precision health represents a break with tradition. And for such efforts to work, the business case needs to be strong. Simply put, the system needs to learn how to assess and create value in a different way. An enhanced focus on wellness and prevention as part of everyday life not only holds the promise of improving patient health but of cutting healthcare costs by heading off costly medical conditions and spurring helpful interventions. On a population-wide scale, the savings could significantly reduce national health spending and improve productivity through reductions in presenteeism and hours of work lost to illness.
But the business case often will depend on the disease realm. Preventative spending for most neurological diseases likely would yield a low return because today’s therapies slow down, but don’t prevent, the conditions. By contrast, preventative dollars targeting cardio-metabolic diseases and certain cancers and infectious diseases likely would yield a higher return because existing lifestyle interventions, screenings and vaccines can prevent the onset of these costly conditions.
For example, the CDC estimates that more than 34 million Americans have diabetes and that 88 million US adults are pre-diabetic. About one of every four dollars of US healthcare costs is spent each year caring for people with diabetes. The annual direct medical cost is estimated at US$237 billion, and another US$90 billion is lost due to reduced productivity. Yet, among at-risk patients, the incidence of type 2 diabetes can be cut 58% with lifestyle intervention and by 31% with the first-line treatment metformin, compared with a placebo, a study found.
Use of precision molecular diagnostics or pharmacogenomics for six common conditions—cancer, diabetes, heart disease, hypertension, lung disease and stroke—has enormous potential to prevent disease by identifying those at risk and enabling prophylactic therapy, US researchers found. Over 50 years, a 10% reduction in disease incidence would generate US$33 billion to US$114 billion in economic value, depending on the condition, in the form of longer, healthier lives.
The precision mentality also has an important role to play in drug and diagnostic R&D. A precision approach promises to cut total costs by identifying the most promising drug targets in stratified patient populations, resulting in higher efficacy and a higher probability of success for clinical development.
By leveraging a computational-knowledge network that merges biomedical, clinical, and social and behavioural information, precision medicine also holds the potential to improve efficiencies in clinical trial processes, as well as accelerate clinical development. Even a conservative estimate puts the cost savings of using precision medicine over current, conventional methods in drug development at 17%, leading to a potential annual savings of US$26 billion for the industry worldwide, notes a PwC Strategy& report.
Payers, however, are concerned about the rising costs of innovative therapies, such as CAR T-cell therapies (US$200,000 to US$300,000), and costly prevention initiatives rolled out on a broad scale. Collection of real-world evidence to show the value of precision therapies and prevention initiatives will be necessary to allay this concern.
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