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Open Access Highly Accessed Review

Personalizing health care: feasibility and future implications

Brian Godman123*, Alexander E Finlayson4, Parneet K Cheema5, Eva Zebedin-Brandl67, Inaki Gutiérrez-Ibarluzea8, Jan Jones9, Rickard E Malmström10, Elina Asola11, Christoph Baumgärtel12, Marion Bennie132, Iain Bishop13, Anna Bucsics6, Stephen Campbell1415, Eduardo Diogene16, Alessandra Ferrario17, Jurij Fürst18, Kristina Garuoliene19, Miguel Gomes20, Katharine Harris4, Alan Haycox21, Harald Herholz22, Krystyna Hviding23, Saira Jan24, Marija Kalaba25, Christina Kvalheim23, Ott Laius26, Sven-Ake Lööv27, Kamila Malinowska2829, Andrew Martin30, Laura McCullagh31, Fredrik Nilsson32, Ken Paterson33, Ulrich Schwabe34, Gisbert Selke35, Catherine Sermet36, Steven Simoens37, Dominik Tomek38, Vera Vlahovic-Palcevski39, Luka Voncina40, Magdalena Wladysiuk28, Menno van Woerkom41, Durhane Wong-Rieger42, Corrine Zara43, Raghib Ali44 and Lars L Gustafsson1

Author Affiliations

1 Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden

2 Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

3 National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil

4 King’s Centre for Global Health, Global Health Offices, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK

5 Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada

6 Hauptverband der Österreichischen Sozialversicherungsträger, 21 Kundmanngasse, AT-1031, Wien, Austria

7 Institute of Pharmacology and Toxicology, Department for Biomedical Sciences, University of Vienna, Vienna, Austria

8 Osteba Basque Office for HTA, Ministry of Health of the Basque Country, Donostia-San Sebastian 1, 01010, Vitoria-Gasteiz, Basque Country, Spain

9 NHS Tayside, Kings Cross, Dundee DD3 8EA, UK

10 Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, Karolinska University Hospital Solna, SE-17176, Stockholm, Sweden

11 Pharmaceutical Pricing Board, Ministry of Social Affairs and Health, PO Box 33, FI-00023 Government, Helsinki, Finland

12 Austrian Medicines and Medical Devices Agency, Traisengasse 5, Wien, Austria

13 Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK

14 Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK

15 NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK

16 Unitat de Coordinació i Estratègia del Medicament, Direcció Adjunta d'Afers Assistencials, Catalan Institute of Health, Barcelona, Spain

17 London School of Economics and Political Science, LSE Health, Houghton Street, London WC2A 2AE, UK

18 Health Insurance Institute, Miklosiceva 24, SI-1507, Ljubljana, Slovenia

19 Medicines Reimbursement Department, National Health Insurance Fund, Europas a. 1, Vilnius, Lithuania

20 INFARMED, Parque da Saúde de Lisboa, Avenida do Brasil 53, 1749-004, Lisbon, Portugal

21 Liverpool Health Economics Centre, University of Liverpool, Chatham Street, Liverpool L69 7ZH, UK

22 Kassenärztliche Vereinigung Hessen, 15 Georg Voigt Strasse, DE-60325, Frankfurt am Main, Germany

23 Norwegian Medicines Agency, Sven Oftedals vei 8, 0950, Oslo, Norway

24 Clinical Programs, Pharmacy Management, Horizon Blue Cross Blue Shield of New Jersey, Newark, USA

25 Republic Institute for Health Insurance, Jovana Marinovica 2, 11000, Belgrade, Serbia

26 State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia

27 Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden

28 HTA Consulting, Starowiślna Street, 17/3, 31-038, Cracow, Poland

29 Public Health School, The Medical Centre of Postgraduate Education, Kleczewska Street, 61/63, 01-813, Warsaw, Poland

30 NHS Greater Manchester Commissioning Support Unit, Salford, Manchester, UK

31 National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, Ireland

32 Dental and Pharmaceuticals Benefits Agency (TLV), PO Box 22520 Flemingatan 7, SE-104, Stockholm, Sweden

33 University of Glasgow, Glasgow, Scotland, UK

34 University of Heidelberg, Institute of Pharmacology, D-69120, Heidelberg, Germany

35 Wissenschaftliches Institut der AOK (WIDO), Rosenthaler Straße 31, 10178, Berlin, Germany

36 IRDES, 10 rue Vauvenargues, 75018, Paris, France

37 KU Leuven Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium

38 Faculty of Pharmacy, Comenius University and Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia

39 Unit for Clinical Pharmacology, University Hospital Rijeka, Krešimirova 42, 51000, Rijeka, Croatia

40 Ministry of Health, Republic of Croatia, Ksaver 200a, Zagreb, Croatia

41 Dutch Institute for Rational Use of Medicines, 3527 GV, Utrecht, Netherlands

42 Institute for Optimizing Health Outcomes, 151 Bloor Street West, Suite 600, Toronto, ON M5S 1S4, Canada

43 Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023, Barcelona, Spain

44 INDOX Cancer Research Network, Cancer Epidemiology Unit, University of Oxford, Oxford, UK

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BMC Medicine 2013, 11:179  doi:10.1186/1741-7015-11-179

Published: 13 August 2013

Abstract

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.

Keywords:
Biomarkers; Drug development; Genomics; Genotyping; Healthcare policy; Pharmacogenetics precision medicine; Personalized medicine; Health authorities; Rational use of medicines; Reimbursement; Targeted treatments