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.
The Global Health Priorities Research Group that Ole Frithjof Norheim leads, has in 2019 grown and developed into a center - the Bergen Centre for Ethics and Priority Setting (BCEPS). With funding from the Bill & Melinda Gates Foundation, Trond Mohn Foundation, Norad and the University of Bergen, BCEPS aims to study the ethics and economics of priority setting in health services. Its main area of focus is decision support for universal health coverage in Ethiopia, Malawi and Zanzibar.
Although with a strong global health focus, BCEPS is also committed to work on priority setting challenges in Norway. The collaboration with CCBIO on cancer biomarkers, precision medicine and fair priority setting is central to this aim.
The aim of CCBIO is to discover, validate and translate cancer biomarkers, a key component of precision medicine. Norheim’s group is interested in how cancer biomarkers can inform and hopefully improve health care priority setting. How is our ethical thinking about treating people as equals challenged when biomarkers and other individual characteristics stratify patients into smaller and smaller subgroups, with only some being offered new and potentially life-saving treatments?
The group will continue the two projects addressing priority setting challenges in personalized cancer medicine:
A PhD project investigating how cancer biomarkers inform treatment recommendations for new and expensive cancer drugs. This will be done in two different studies: one survey experiment investigating physicians’ preferences when deciding who will be given priority to receive a new cancer drug, and one study examining how new cancer drugs, and especially those involving biomarkers, are evaluated in the Norwegian drug reimbursement system.
Work together with the ELSA group on two interrelated projects: one theoretical work investigating the ethical challenges emerging when using biomarkers to stratify larger patient groups into smaller and more personalized sub-groups. The other project addresses policymakers in an attempt to open a constructive dialogue about how new personalized cancer drugs best can be evaluated, and what implications this has for actual priority setting.
The first article in the PhD project was published in BMC Cancer in May 2018. In this paper, the role of patient age in clinical decision making is examined and provides a base for important future work.
The group will continue to work on priority setting at both clinical and policy levels. In addition, more theoretical work on the role of cancer biomarkers in priority setting is necessary to answer the pressing ethical question: how to treat people as equals. This stream of work will be conducted in close collaboration with CCBIO’s ELSA group. To continue the good dialogue and exchanges with other CCBIO researchers and clinicians is also a priority.
Current challenges in the field
The increasing amount of new and expensive cancer drugs entering the market offer opportunities, but also challenges. With often marginal effect and unreasonable and confidential pricing, these drugs will impose a heavy burden on our publicly financed health care system. Also, it is not clear how biomarker tests, next generation sequencing and other diagnostics should be assessed in the reimbursement system.