prescribed to all patients with the same diagnosis), generating increasingly tailored
interventions. Because the vast majority of conventionally applied health technol-
ogies are tested on broad populations and prescribed using statistical averages, the
approach of personalized medicine may prove challenging for the conventional
methods of economic evaluations because of its increasing focus on the individual
patient.
However, the narrower focus on a single individual does not suggest that every
single patient is to receive a single, personalized medication; instead, the interven-
tions are designed for specific groups of patients who share a genetic marker. The
number of targeted patients or patient groups will therefore vary based on the
characteristics of the shared genetic marker and the characteristics of the health
care intervention. In turn, this means that the patients who cannot benefit from the
treatment will not be administered treatment. This approach to treatment carries a
promise of reducing unwanted side effects of ineffective treatments and reducing
health care expenditures. The question is, how can economic evaluations best adapt
to and adequately assess the cost-effectiveness of “personalized” interventions
developing in medicine?
Personalized medicine can be defined and characterized in several ways, as
discussed for instance by Redekop and Mladsi ( 2013 ), which to a certain degree
determine the framework of the debate about the economic assessment of person-
alized medical products. According to the European Science Foundation, person-
alized medicine seeks to integrate data on the entire dynamic biological makeup of
each individual as well as the environmental and lifestyle factors that interface with
this makeup to generate a complex, individual phenotype.^5 This information about
the individual’s phenotype is what offers physicians the possibility to prescribe
more effective drugs and avoid prescribing (ineffective) drugs with known side
effects, hence reducing trial-and-error inefficiencies that cost time and money,
potentially drive health care costs upwards, and cause harm to patients (in terms
of undesirable side effects, time wasted, lives lost). On the other hand, it could also
be argued that any treatment, medical device, or a prevention action adjusted to the
individual’s particular needs is, by definition, a personalized medical approach. For
instance, patients in need of an artificial hip need not receive a generic (“one size
fits all”) artificial hip, but instead, each patient may receive a hip designed exactly
to match the patient’s bone and cartilage structure, and other particular features,
created by a 3D printed. This personalized hip implant can be an example of a
personalized medicine approach. Ultimately, as also argued by Redekop and Mladsi
( 2013 ), all medical treatments should be personalized in the sense that the physician
advises the patient while holding the patient’s preference in mind, using the
evidence on the benefits and risks of the treatment, and accounting for the associ-
ated costs both to the patient and the payer. In this chapter, however, we do not
(^5) This definition is available in the brochure titled “Personalised Medicine for the European Citizen
- Towards more precise medicine for the diagnosis, treatment and prevention of disease”
published by the European Science Foundation in 2012.
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