How Economics Can Shape Precision Medicines

Ariel Dora Stern; Brian M. Alexander; Amitabh  Chandra

Article | Science | March 17, 2017

How Economics Can Shape Precision Medicines

by Ariel Dora Stern, Brian M. Alexander and Amitabh Chandra

Abstract

Many public and private efforts in coming years will focus on research in precision medicine, developing biomarkers to indicate which patients are likely to benefit from a certain treatment so that others can be spared the cost—financial and physical—of being treated with unproductive therapies while more easily uncovering therapeutic signals. However, such research initiatives alone will not deliver new medicines to patients in the absence of strong incentives to bring new products to market. We examine the unique economics of precision medicines and associated biomarkers, placing an emphasis on the factors affecting their development, pricing, and access.

Keywords: Health Care and Treatment; Research; Economics; Motivation and Incentives;

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Citation:

Stern, Ariel Dora, Brian M. Alexander, and Amitabh Chandra. "How Economics Can Shape Precision Medicines." Science 355, no. 6330 (March 17, 2017): 1131–1133.

For more than two decades, scientific advances have been driving profound changes in drug discovery and the drug industry itself. This case provides an overview and description of these technical and scientific advances. Written for the nonscientific reader, it may be used as companion reading for other case materials that require basic knowledge of the tools, techniques, and approaches used in the pharmaceutical and biotechnology industries.

In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with, but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but do so at the expense of dynamic efficiency (slowing innovations in new treatments). The smaller the Medicare program is relative to the commercial market, the less important this is; but in a world where there are no market prices or the private sector is very small, the task of setting prices that are dynamically correct becomes more complex. Reforming Medicare should focus on greater incentives to increase competition between Medicare Advantage plans, which necessitates a role for government in ensuring competition; premium support; less use of regulated prices; and less appetite for countless “pay for performance” schemes. We apply this framework to evaluate Medicare for All proposals.

The development of intelligent machines holds great promise for making health care delivery more accurate, efficient, and accessible, but challenges remain for incorporating AI into clinical and administrative settings.

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How Economics Can Shape Precision Medicines

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