At FHU, the Health Economics Team of the Dijon Economics Laboratory (EES-LEDI, University of Burgundy) is taken up with three major issues, the first relating to collective issues (social, economic and organizational), the second relating to the preferences of individuals, patients and professionals, the third concerns the criteria for evaluating these technologies.
Collective challenges (social, economic and organisational)
HTS is a major innovation in medicine. Its diagnostic use in medical practice poses a significant challenge to society as regards its effect on the health system and its economic relevance. The issue has to do with the appropriateness of the technology to our health system, based on the rationale of sustainability and the increasing spread of HTS.
- Evaluation of the impact of introducing innovative technologies into the healthcare system
The introduction of HTS into the clinical practice of genetics will have an impact on the health system, both the healthcare system and the funding scheme. Consequently, an analysis of the changes required in the organisation of treatment paths and in the co-ordination of private practice and hospital practitioners must be undertaken. Equitable access to these new technologies is clearly an important criterion for evaluating the impact of such changes; it involves looking at the distribution of the HTS equipment as well as the social disparities relating to access. Lastly, the spread of this innovation must be analysed in relation to its funding, and the resources that will be put into it by the community and by health insurance.
- Evaluation of requirements in terms of new skills and care reorganisation as a result of the introduction of HTS
HTS is a highly reliable tool which is required for changes to the organisation of health institutions, and at a broader level, the health system. Skills and the connections between experts in molecular genetics and other health professionals will have to be reshaped in order to address the needs of patients and, at a wider level, those of society. It involves evaluating these changes and the impact of HTS introduction on health institutions, particularly in relation to the requirement for new skills, new professional networks and expansion in clinical medicine.
Individual challenges: patient preferences and professional preferences
Societal concerns aside, HTS will directly affect patients in need of a genetic diagnosis, as well as health professionals. To examine these impacts, research is being focused on analysing the preferences of doctors and patients with respect to genetic diagnosis via new technologies. Firstly, genetic diagnostics via HTS entails a different perception of epidemiological data by patients and/or their relatives ; it is necessary to evaluate their perception of the risk, assess their desire to know the results generated by this new technology and the ensuing decisions, which have implications for them, their children and possibly the other members of their family. Do patients want to be informed via HTS diagnostics ? Do they have a sense of the risk measured by this technology ? Do they fully understand the limitations of these results ? Secondly, practitioners and other health professionals need to be informed in order, among other reasons, to help patients and parents in the decision-making process. Their own perceptions, preferences or assessment of HTS will influence those of the patient and the patient's family circle. Gauging these preferences and putting tools in place to inform practitioners and health professionals is a challenge when developing genetic diagnostics. With this intention in mind and with a view to improving the care of patients and their families, the method of conservative choice is an appropriate approach to revealing the preferences of patients, their parents and doctors. These issues are being examined by the Health Economics Team and the Bourgogne/Franche-Comté Discussion Platform on Ethics (EREBFC).
Medico-economic evaluation of the introduction of HTS into diagnostic practice
Molecular genetics is a highly efficient diagnostic tool that can in some instances become a substitute for more costly or invasive medical practices. In order to improve both health service efficiency and patient care, attention must be paid to HTS, from the perspective of medico-economic evaluation. Conventional evaluation methods must be reformed to incorporate all the specific features of this technology. The type and extent of the benefits gained would appear to be a more complex matter in this instance; the concept of clinical usefulness as a results indicator ought to be re-examined, squarely tackled, and complemented with the element of person usefulness. The gains in terms of life expectancy and quality of life, as well as the costs, associated with HTS will be evaluated by means of cost-benefit analyses. Furthermore, a multi-criteria methodology would examine economic, technological, social and organisational facets within a single analytical framework.