Page 157 - Genomic Medicine in Emerging Economies

146 CHAPTER 8: E c o n omic Evaluation and Cost-Effectiveness Analysis

In view of these factors, in most countries, governments or health insurers
have taken initiatives to influence the price and utilization of health care
technologies with the use of health technology assessment (economic eval-
uation) in health care (Drummond et al., 2015). One stated objective of
these schemes is to encourage efficiency or cost-effectiveness. In principle,
economic evaluation should be relevant to decisions about the pricing and
reimbursement of health technologies, as it offers a way of estimating the
additional value to society of a new intervention (such as a genetic technol-
ogy) relative to current therapy. Often the application of economic evaluation
in pricing and reimbursement is subjected to changes among countries, but
in most cases represent, ideally, a tool for the rational use of limited recourses
(Fragoulakis et al., 2015).

Herein, we review economic evaluation and cost-effectiveness data (or their
lack of) concerning developing and emerging countries worldwide. Europe
will serve as a model to point out that despite recent advances in genomic
medicine and health economics, pharmacogenomics is still in its infancy for
the majority of low-resourced and developing European countries.

DEVELOPING AND EMERGING COUNTRIES—A
WORLDWIDE PERSPECTIVE

Pharmacogenomics appears to be a useful tool for the formulation of pub-
lic health decisions in the developing and emerging world, as it attempts to
have a beneficial impact on patients via optimum decision-making and disease
management. No doubt, to reach its anticipated potential, pharmacogenomics
has to overcome current scientific, legal, ethical, political, and economic chal-
lenges. For this to occur, an innovative collaboration between various stake-
holders, such as health care providers, universities, and nongovernmental and
international organizations is required.

Even though emerging countries have been considered appropriate for pri-
vate investments, much still has to be done in these countries from a social
standpoint.
Indeed, an emphasis should be given to improving healthcare delivery infra-
structure, to facilitating access to preventive and curative care, and to provid-
ing health insurance coverage for a broader population. Indicatively, in India,
most of its 1.2 billion population is lacking proper access to healthcare, as only
the very wealthy can afford to visit private hospitals, equipped with the latest
imaging and medical devices (Rebecchi et al., 2016). Currently, the achieve-
ment of universal health coverage in emerging economies is of high priority
to the global community to ensure that such countries will sustainably grow
on a long-term basis. Some emerging countries, such as China, have made