EU policies in personalized medicine-related technologies

An overview of Personalized Medicine landscape and policies in the European Union

BACKGROUND

The spread of Personalized Medicine (PM) over the last decade defined a revolution in healthcare systems. PM is among the priorities of the European Commission's research agenda, which funded the IC2PerMed international project aiming to integrate China into the International Consortium of PM (ICPerMed). In the context of this project, we mapped the existing policies related to PM in the European Union (EU) and at the EU Member States (EU-MS) level.

METHODS

PubMed, Google Scholar, Google, Microsoft and national and international institutions' official repositories were searched in order to identify documents on PM-related policies, programmes and action plans at the EU and EU-MS level, published up to December 2020.

RESULTS

We identified 28 policies in the EU aimed at improving public health promoting and fostering PM implementation, through some actions including the standardization of good medical practice, use of big data and digital innovation, data sharing and cross-border interoperability, healthcare sustainability, disease prevention and patients'/citizens' engagement. We identified 23 policies at EU-MS level which, notwithstanding national differences, have a common focus, such as patient-tailored treatment and targeted prevention, education of healthcare workers, research and innovation, big data harmonization and healthcare system sustainability.

CONCLUSIONS

The definition of an integrated regulatory framework is essential to turn PM into an opportunity for citizens and patients with the involvement of all the stakeholders. This work can provide a valuable tool for decision-makers to define common approaches, priorities for research, development and increase international collaboration, which could overcome the fragmented European scenario and align the future direction on PM.

An index of barriers for the implementation of personalised medicine and pharmacogenomics in Europe

BACKGROUND

Personalised medicine (PM) is an innovative way to produce better patient outcomes by using an individualised or stratified approach to disease and treatment rather than a collective treatment approach for patients. Despite its tangible advantages, the complex process to translate PM into the member states and European healthcare systems has delayed its uptake. The aim of this study is to identify relevant barriers represented by an index to summarise challenging areas for the implementation of PM in Europe.

METHODS

A systematic literature review was conducted, and a gaps-and-needs assessment together with a strengths-weaknesses-opportunities-and-threats analysis were applied to review strategic reports and conduct interviews with key stakeholders. Furthermore, surveys were sent out to representatives of stakeholder groups. The index was constructed based on the priorisation of relevant factors by stakeholders.

RESULTS

A need for stakeholder-agreed standards at all levels of implementation of PM exists, from validating biomarkers to definitions of 'informed consent'. The barriers to implement PM are identified in 7 areas, namely, stakeholder involvement, standardisation, interoperable infrastructure, European-level policy making, funding, data and research, and healthcare systems.

CONCLUSIONS

Challenges in the above-mentioned areas can and must be successfully tackled if we are to create a healthier Europe through PM. In order to create an environment in which PM can thrive for the patients' best outcomes, there is an urgent need for systematic actions to remove as many barriers as possible.

Translational research policies: disruptions and continuities in biomedical innovation systems in Austria, Finland and Germany

Increasing the rate of biomedical research that is relevant to clinical innovation has been an intensifying concern of the research community and of policy-makers. In response, some of these actors have recently promoted varied approaches they label as translational research (TR) and translational medicine. This movement started in the USA in the early 1990s, and has since evolved to encompass large and ambitious initiatives. Its advocates contend that the productivity of biomedical innovation systems can be bolstered by: (1) the extension of large-scale development collaborations; (2) the strengthening of clinical experimental platforms; (3) training and supporting dedicated human capital; (4) achieving higher collective coordination of research teams than was previously common practice. In this paper, we examine to which extent these objectives have been put into practice by communities of biomedical actors and policymakers, by characterizing current translational initiatives in three European countries—Austria, Finland and Germany. This research draws on an analysis of policy documents and 26 semi-structured interviews conducted with policy-makers and TR advocates from these countries. Traditions of science and technology policy-making in each country have made them differentially receptive to the TR movement. German biomedical actors have most fully put into practice TR propositions, while Finland has seen policy-level debate of the notions but little in the way of concrete implementation and Austria appears to be a middle case.

Application of cost-effectiveness analysis to demonstrate the potential value of companion diagnostics in chronic myeloid leukemia

AIM

A cost-effectiveness analysis was performed to assess the potential value of companion diagnostics in supporting treatment decisions for dasatinib and nilotinib in chronic myeloid leukemia.

MATERIALS & METHODS

A decision model was developed, and model inputs were taken from the literature and publicly available sources. The perspective of the healthcare sector in the Netherlands was used. Sensitivity and scenario analyses were performed to assess uncertainty in the results.

RESULTS

Companion diagnostics could improve health and reduce costs, despite the estimates being uncertain owing to limited evidence for comparative effectiveness between dasatinib and nilotinib. The results were sensitive to the cost of treatment, utility of progression and progression-free survival.

CONCLUSION

This case demonstrates the use of cost-effectiveness analysis at an early stage of health technology assessment to generate economic evidence for the use of companion diagnostics in treatment decisions and to support decision-making for their development.

Legal and ethical concerns in personalized medicine: a European perspective

Expectations in the integration of pharmacogenomics into clinical practice remain high in a number of therapeutic areas. This review focuses on the key legal and ethical issues concerning personalized medicine that have given rise to debate, law-making and/or Court decisions in Europe, especially involving: trial subject stratification during clinical trials; the protection of innovation in pharmacogenomics through intellectual property rights; the regulation of access to genetic testing; the regulatory framework for genetic testing devices; gene-based discrimination; legal duties and liabilities resulting from 'tailored' medicine; and confidentiality issues with respect to family members. This article explains these issues and identifies some of the difficulties encountered in seeking to build a harmonized legal framework within Europe.