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.
Health economics in CCBIO has a dual focus on the economic evaluation of cancer biomarkers and on understanding the incentives to combine biomarkers with patented medicines. Health economics is an integral part of the Ethics, Economics and ELSA Research in CCBIO. The Health Economics Group has collaborated successfully in the provision of the course CCBIO903 Cancer Research - Ethical, Economic and Social Aspects and contributed two chapters to Cancer Biomarkers: Ethics, Economics and Society (ed. Blanchard & Strand, 2017).
The primary health economic projects are the PhDs by Kelly Seo (cost-effectiveness modeling of predictive biomarkers in targeted oncology therapies) and Ana Beatriz Luís (incentives for developing new cancer biomarkers and targeted therapies). Also, a new PhD project has been undertaken by Jiyeon Kang entitled: Improving economic evaluation and decision-making for oncology drugs using real-world data.
Mikyung Kelly Seo and Ana Beatriz Luis completed a paper which explored the evidence for whether the use of cancer biomarkers to guide treatment had improved health outcomes in Norway. Their results suggest that biomarker tests improve health by ensuring that the right treatment is given to the right patient and that the effect is stronger for cancer types for which fewer drugs are available. Mikyung Seo submitted her PhD thesis entitled Economic Evaluations of Cancer Biomarkers for Targeted Therapies at the end of 2019. Part of this research was with CCBIO colleagues assessing the cost-effectiveness of HSP27 as a biomarker in the treatment of metastatic melanoma. John Cairns published a study of cancer drug reimbursement decisions in six European countries.
The two health economics PhDs are well advanced and should be completed over the next year. Plans are currently being developed for a new PhD examining the potential role of observational data in the evaluation of cancer biomarkers to inform priority setting. It is intended to build on the costeffectiveness modeling in Seo’s thesis by developing economic evaluation of specific cancer biomarkers of central interest to CCBIO. In addition, planning is underway for the next CCBIO903 course to be held December 2019 - January 2020. Finally, a collaborative project on priority setting is planned to exploit the strengths and common interests of the Ethics, Economics and ELSA Research Groups. The PhD candidate Kang will continue her review of the one hundred and sixty evaluations of oncology drugs undertaken by NICE in the past ten years. The study documents the increasing use of real world evidence. She will be exploring a number of hypotheses regarding the use of real world data by manufacturers in their evidence submissions and the acceptability of such evidence to decision makers.
Current challenges in the field
Powerful forces are working to change the nature of the evidence on clinical effectiveness that feeds into priority setting processes, these include: the move towards precision medicine with a consequent fragmentation of markets, the perceived need to speed up decision making processes giving patients earlier access to medicines, and an increasing emphasis on real world evidence.