Global Health Priorities - Ole-Frithjof Norheim
Global Health Priorities is an interdisciplinary research group situated at the Department of Global Health and Primary Care at the University of Bergen. The group consists of a team of cross-disciplinary researchers and professionals dedicated to study the ethics and economics of priority setting in global health.
Norheim’s team is interested in how cancer biomarkers can inform health care priority setting. Fair and good priority setting is needed, also in highincome countries. The gap between what is medically possible and what is sustainable for a health care system is increasing, and oncology is one of the main drivers. Yet, research in oncology may also contribute to solutions.
CCBIO’s aim is to discover, validate and translate cancer biomarkers. This will make cancer medicine more personalized. What before were patient groups characterized by common patterns of their cancer will now be individual or small patient groups identified by biomarkers and other individual characteristics. Breast cancer is no longer just breast cancer, and priorities among subgroups will and should differ. This challenges our ethical thinking about treating people as equals.
The team is currently involved in projects addressing the two priority setting challenges in personalized cancer treatment:
• Investigating (PhD project) how new cancer biomarkers influence treatment recommendations for new and expensive cancer drugs. How will a biomarker influence treatment recommendations? In the project, patient age, another individual indicator of risk and expected benefit, is assessed on how it influence treatment recommendations. The team will examine how decisions are being influenced, and also how we think they should be influenced. These two are not always in harmony.
• Together with the ELSA group, economists and others associated with CCBIO, the team is also developing a joint project that will, among other things, investigate how the development from larger patient groups into smaller and more individualized patient groups better can be understood and addressed when prioritizing, approving and reimbursing new and expensive drugs.
Preliminary findings indicate that biomarkers now are used by policymakers to single out subgroups where interventions are more cost-effective than for the average patient. There is also an opposite trend where use of biomarkers leads to more costly drugs for small patient groups.
The team will continue working on the PhD project, adding more theory of ethics and priority setting to the work, and thereby being able to provide some answers to pressing normative questions. They also work to establish collaboration and a good dialogue with CCBIO clinicians to better understand and integrate the clinical mindset into their work, and possibly seed some thoughts about priority setting into the clinical minds too.
Current challenges in the field
The increasing amount of new and expensive cancer drugs that are entering the marked is a challenge. Sometimes their effect is marginal and prices unreasonable. These drugs will impose a heavy burden on our publicly financed health care system. Hard work and tough decisions are required to make sure that increasingly scarce resources will continue to be distributed in a fair and cost-effective way.