Levelling Up series Part 2: Precision testing’s suboptimal HTA - Time to level up.

In reviewing published evidence describing the economics of precision testing, this excellent review paper from 12 months ago piqued our attention and supported our perspective that we have an incomplete economic picture of precision testing. We think it nicely supports our call to level up the economic assessment of better testing.

Read the review: How Are Companion Diagnostics Considered in Economic Evaluations of Oncology Treatments?

A narrative from the paper stood out - as paraphrased in these quick-read quotes:

“From the 27 identified NICE appraisals, we found that only 15 incorporated CDx testing in their economic evaluations… Characteristics of importance regarding the CDx tests were poorly reported or disregarded altogether from the evaluated assessments… .A recent systematic literature review of 22 economic evaluations of CDx for targeted therapies also found that there is no consistent approach in modeling CDx characteristics, specifically in terms of transparency and the level of detail regarding the calculation of costs for the CDx”.

We are left to conclude a number of things:

• The dependence of precision treatments on precision testing is a critical dynamic of our future with healthcare. This is unequivocally a partnership attracting billions of dollars of investment. However, the unequal and inconsistent assessment of the cost-benefits of the testing half of this partnership deny us all a true picture.

• Further that even when the economic lens is run over precision testing (as described so well in this paper), it focuses on direct costs and not on the real outcome benefits. For example, the costs to the system of NOT testing are not (or are rarely) considered.

• We do not run high speed trains on tracks built for steam engines… yet we expect to unlock the outcome benefits of better patient diagnostic pathways without radically better economic assessment. Without alteration the market-based reward for valuable precision testing – so critical to removing the barriers to precision treatment – will remain stuck in a legacy system designed for a different era.

Time to level up.