Modelling the value of personalised medicine to payers

Highlighting the value of personalised medicine for optimising payer budgets: development of a budget allocation tool


The challenge

Personalised medicine plays an important role in guiding treatment decisions across disease areas. Our client was developing a new treatment for Hepatitis C Virus (HCV). Treatment options for HCV had been very limited but the development of new, oral, curative treatments meant additional decisions for the clinician, payer and patient. In this evolving market, manufacturers needed to strategically differentiate their products in order to gain market access and market share.  The objective of this project was to understand the potential value to the payer of personalised medicine through segmenting HCV patients according to existing host biomarkers.

The solution

We designed a multi-step methodology:

  • An evidence review to provide insight and recommendations on which key HCV biomarkers to use within the model.
  • Development of a model that segmented patients according to key biomarkers and assigned treatments to provide the optimal allocation of a fixed payer budget.
  • Gaining of buy-in and feedback on this novel approach from regional market access teams to ensure applicability to the end users.

Key results

The model provided a novel approach to payer budget allocation, showing that patient segmentation according to host biomarkers could help to guide treatment decisions and optimise budget spend.

The model was flexible to different payer objectives, allowing the payer to consider the minimal cost per favourable outcome and to factor in the costs associated with re-treatment if required. Results from the model could be used to help position HCV treatments based on where they might add the most value, thereby maximizing individual clinical outcomes and/or avoiding treatment costs.

Value to the client

As a result of the presentation to regional market access teams, individual markets acknowledged the potential value of this model in engaging the payer audience on optimal allocation of a fixed budget. The model was further developed into a tailored country-level tool for external use in discussions with payers.

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