Where's the value in genomics?
Health economists explore whether the value of genomics can justify the costs – and how we might accurately measure value and cost in this area.
Is genomics too expensive to implement? That depends on how you think about value and expense – including the unnecessary costs already borne by our health system.
Prof Kim Dalziel and A/Prof Chris Schilling have evaluated Melbourne Genomics projects from health economics perspective. They shared their thoughts at The State of Genomic Care summit, and answered tough questions from Lucy Franzmann, a Chief Financial Officer with a keen eye on spiralling healthcare budgets.
Rethinking value
Value is often considered in terms of the cost of a medical intervention compared to its impact on a patient’s health. Prof Dalziel says that genomics requires different thinking. “Because where value lands is not just to individual patients, it's also to families. And it's not just to health outcomes, it's to outcomes beyond health.”
As she explained, understanding value in genomics means considering factors like family impact, quality of life and patient preferences. Designing care with these in mind enhances its relevant and effectiveness.
The cost of imprecise medicine
A/Prof Schilling showed how genomics could cut significant costs already borne by our hospitals – from medications that fail or cause adverse effects, tests that are invasive and unnecessary, readmissions to hospital, and low-value care.
In particular, he cited the use of pharmacogenomics to improve the success of organ transplants, an example of expensive and high-intensity care.
“We’re already bearing the cost of imprecise medicine,” he said. “And that can be saved or mitigated to a great degree.”
Where equity and value intersect
A/Prof Dalziel believes that efforts to make genomics more equitable will amplify its overall value and impact.
“For under-served populations and vulnerable populations, often there's a bigger amount to be gained through the optimisation of care. So then when we do the economics cost versus benefit, that benefit side of the equation is often huge."
How to measure value in genomics
Both health economists stated that value measurements needed to factor in:
- early detection of conditions that can be prevented or mitigated
- prevention of waste through imprecise medications and unnecessary investigations
- models of care best suited to different contexts
- productivity of the health workforce
- long-term patient trajectories
- individual and family wellbeing and productivity
To realise this value, all aspects of genomic care needed to be considered, not just the test itself. Systems change was also needed – including integrated data systems, aligned funding models, and ways to optimise the current health workforce.
As Prof Schilling said: “Making sure that we've got the systems in place to actually be clear about who's getting access to genomic and genetic tests … is a low-hanging-fruit piece of innovation that would actually really help us to hit the goals that we want to hit.”
How can your hospital provide value-based genomic care? The Genomics and Your Hospital toolkit has tools to help.