Prioritization (2016)
An increasingly older population, new and expensive treatments and higher public expectations will make fair priority setting essential to maintain a sustainable and just health care system. Through the work of CCBIO, functional cancer biomarkers can evolve to play an important role in this process.
Main content
Precision medicines that target specific聽immune responses or signaling聽pathways give new hope and treatment聽options for a range of advancedcancers. However, the price is literally聽high. Costs per quality adjusted life聽year (QALY) gained is pushing towards聽1 000 000 NOK and beyond, and the聽demand from patients, physicians and聽the general public for implementing聽new drugs is strong. But despite talks聽of a paradigm shift in cancer treatment,聽documented treatment benefits remain聽marginal for some.
Tailoring treatment so that the appropriate聽medicine is given to the appropriate聽patient, can increase treatment聽benefits, reduce side effects and unnecessary聽treatment, and also potentially聽reduce treatment costs. It is not controversial聽to assign biomarkers a central聽role in this scenario of clinical priority聽setting, but exactly how biomarkers聽best can be used is still to be explored.聽How will biomarker test results influence聽the physician鈥檚 decision making?聽How will average-based calculations of聽cost and effect be affected by the more聽detailed and individualized stratification聽of cancer disease using biomarkers?聽How will society accept that seemingly聽identical cancer patients are given聽different priority and therefore completely聽different treatments?
The 2016 White Paper on priority setting,聽鈥淰alues in patient health care鈥�,聽and the subsequent political discourse,聽demonstrated a broad support for the聽overall goal of the health care system:聽the greatest number of healthy life years聽for all, fairly distributed. This will be聽achieved through three criteria for聽priority setting: the priority of an intervention聽increases with the expected聽utility from the intervention; the priority聽of an intervention increases the less聽resources it requires; and the priority聽of an intervention increases with the聽severity of disease in the absence of聽such an intervention.
Cancer biomarkers have the potential聽to influence all priority decisions: they聽can help predict the benefit of a selected聽treatment, save resources through better聽selection of patients, and give prognostic聽guidance to evaluate disease severity.聽Therefore, cancer biomarkers have the聽potential to influence health care priority聽setting at all levels.聽
There are hundreds of new drugs in the聽pipeline, not only for cancer, but also聽for common and often chronic diseases聽like cardiovascular diseases, diabetes,聽autoimmune and rheumatic diseases.聽Vaccines, antibodies, stem cell treatment聽and gene therapy will provide聽a range of new treatment options that聽certainly will generate more health.聽However, without guidance and reliable聽tools for priority setting, our health care聽system will not be able to maximize聽health and distribute it fairly.
CCBIO鈥檚 work on developing better biomarkers聽can not only contribute to better聽treatment for each individual cancer聽patient, but also inform and facilitate聽the priority setting processes. This may聽benefit both individual patients and聽society as a whole.