Health economics at CCBIO is concerned with two major research problems: what is the cost-effectiveness of biomarkers, and how does the interplay between the diagnostic market and the pharmaceutical market affect incentives to invest in R&D for cancer biomarkers, termed the industrial organization of biomarkers.
The Health Economics Research Group is located at the Department of Economics, University of Bergen, in close cooperation with the London School of Hygiene and Tropical Medicine (LSHTM) in the UK.
The primary project is in the form of a PhD being undertaken by Kelly Seo. The overall aim of this PhD is to inform the potential value of biomarkers throughout the process of technology development. To do this, a generic economic model will be developed integrating cost-effectiveness analysis and value of information analysis. The first stage is a systematic literature review on economic evaluations of predictive biomarkers in oncology. This will provide a systematic and critical review of the cost-effectiveness of predictive biomarkers and modeling approaches used in previous studies. As part of this wider review, an initial review of biomarkers and targeted therapies for metastatic colorectal cancer (mCRC) has been completed.
Another ongoing project (undertaken jointly with Beatriz Luis) is examining the impact of cancer biomarkers on health outcomes in Norway. It addresses two research questions: has the introduction of cancer biomarkers had a positive impact on health outcomes in the Norwegian population, and what is the difference in premature mortality in Norway between targeted therapies with and without companion diagnostics?
Cancer biomarkers for targeted therapies in mCRC improve the costeffectiveness of targeted therapies. However, this does not ensure that the therapies themselves are cost-effective. While companion biomarkers reduce therapy costs, the savings are not sufficient enough to make these treatments cost-effective. The studies that evaluate biomarkers have often restricted attention to the cost of tests and do not always consider the characteristics of the test or the prevalence of the marker.
Current challenges in the field
A specific continuing challenge is to capture accurately the health benefits from adopting new health technologies. These arise in two areas in particular: the time to event analyses and the valuation of different health states which underlie the estimation of qualityadjusted life-years (QALYs). A broader challenge of increasing importance is how to decide which health technologies should be introduced in routine clinical practice. As clusters of new drugs arrive in close succession, the challenge is to make a timely determination of which should be adopted, particularly as treatment strategies become more stratified (possibly as a result of increased use of biomarkers). An excellent example of this is the treatment of non-small cell lung cancer.