Precision Medicine (PM) and Population Health may seem contradictory concepts, with PM focusing on individual characteristics of each patient and Population Health focusing on outcomes of a large group of people. The bridge between the two is precision health (PH), a broader holistic approach, integrating individual and population-specific data to provide positive outcomes for a large group of people.

When last year EFPIA approached the EFPIA Oncology Platform (EOP) for a joint project on the potential of Precision Medicine and precision health to address common diseases at population level, I thought “interesting, bold”. I liked the chance to take PM out of the ivory tower, debunk the myth that PM is a “solution for a few”.

PM brings value for individual patients, but its greatest impact is at the population level: this is the outcome of the research done by EFPIA, with Charles River Associates available in the recently published report Adoption of precision health and precision medicine approaches in addressing population health needs in Europe.

From myth to reality: by focusing on individual information and genomics and channeling the right approach to the right patient at the right time we can reach benefits at population level.

One of the examples of the report relates to COVID-19, not a disease of a few, but a pandemic: the use of genomic sequencing enabled more effective disease surveillance and the development of vaccines targeting specific mutations in different strains of the virus. This approach proved how PM can bring significant value in prevention at population level.  

The report highlights that personalised care approaches emerge as the way to gain efficiency in the system and that we need collectively to intensify the effort for policies which can facilitate PM adoption in Europe.

In PM, oncology is the tip of the spear: cancer is a disease of the human genome and PM has been playing a critical role for decades in providing a better understanding of the disease pathology and tumors mutational profile. ^{(1) (2)} Based on this knowledge, the development of diagnostics, including next-generation sequencing, equips clinicians with more precise tools to identify patients likely to benefit from targeted therapies and reduce adverse events.

In addition to benefits to individuals, PM also brings efficiency in resources allocation, cost saving and cost effectiveness advantages for the healthcare systems.

A study on the management of advanced Non Small Cell Lung Cancer (NSCLC) reveals that while PM approaches may lead to increased costs for biomarker testing and medicines in all countries, other healthcare costs are decreased, notably for the treatment of adverse events and end-of-life care ⁽³⁾.

Another analysis from a large Irish private hospital revealed cost saving opportunity from reduced adverse events. With a cost of €23,718 for universal screening versus €232,061 in hospitalization expenses for side effect management, it demonstrates a significant opportunity for cost savings ⁽⁴⁾.

The value of PM does not stop at individual or healthcare system level: there is an increased socio-economic value for productivity according to a study of Dzau et al. (2015), which found that PH/PM innovation could generate hundreds of billions of Euros in value in the form of longer, healthier lives enjoyed by patients ⁽⁵⁾.

Over the years, the EU Commission has displayed a firm commitment to PM, with a wise mix of push and pull strategies, merging successfully bottom-up activities from Member States and top-down actions from the EU Institutions.

With the Europe's Beating Cancer Plan (EBCP) and the EU Cancer Mission we have a flourishing momentum with several initiatives in Precision Medicine and Population Health, such as: Uncan, to understand cancer; Can.Heal to unleash the power of public health genomics, diagnostics and treatment for all; PCM4EU for personalised cancer medicine for all EU Citizens; and PRIME-ROSE, for a precision cancer medicine trial network.  

All of the above is creating a thriving innovation oncology research eco-system across Europe, however, we still witness disparities in the adoption of Precision Medicine. Disparities that negatively impact patients who  “wait in average” 100 days more to access selected targeted therapies versus all oncology medicines. But for patients and us all, every day counts. 

We can reduce inequities in access to PM and PH innovations through smart investments and scaling up initiatives.

With a push and pull strategy and a hub and spoke model, the EU could foster a world-leading cancer research environment. It could support Member States to intensify and sustain investment in genome-based innovations and infrastructure with supportive policies and regulatory environment to optimize such investments.

All the initiatives outside of the cancer arena (e.g., General Pharmaceutical Legislation, European Health Data Space, Health Technology Assessment Regulation, In Vitro Diagnostics Regulation) should converge – and not clash against each other’s - to materialize the vision of the EU Cancer Mission to save 3 Million lives by 2030.

There should not be contradiction with unintended consequences between all these legislative files as well as there is no contradiction between Precision Medicine and Population Health. There is a way forward for the benefit of patients and families in need, for healthcare systems, and for society. Precision Medicine can help face the health and wealth multi-challenges of an aging population, an increase prevalence in chronic diseases and risk of future pandemics.

Make it personal, for the benefit of all.

Make it sustainable and end the inequity (and unsustainability) of the “one size fits all” approach.

Don’t miss the opportunity to learn from advances in PM in cancer care which could be translated to a broader range of disease areas.

⁽¹⁾ Krzyszczyk, P., Acevedo, A., Davidoff, E. J., Timmins, L. M., Marrero-Berrios, I., Patel, M., White, C., Lowe, C., Sherba, J. J., Hartmanshenn, C., O'Neill, K. M., Balter, M. L., Fritz, Z. R., Androulakis, I. P., Schloss, R. S., & Yarmush, M. L. (2018). The growing role of precision and personalized medicine for cancer treatment. Technology, 6(3-4), 79–100. https://doi.org/10.1142/S2339547818300020 50

⁽²⁾ Enabling Precision Medicine in Oncology. (n.d.). Retrieved October 19, 2022, from https://emea.illumina.com/destination/Precision-Oncology.html

⁽³⁾ Hofmarcher, T., Malmberg, C., & Lindgren, P. (2023). A global analysis of the value of precision medicine in oncology – The case of non-small cell lung cancer. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1119506

⁽⁴⁾ Murphy, C., Byrne, S., Ahmed, G., Kenny, A., Gallagher, J., Harvey, H., O'Farrell, E., & Bird, B. (2018). Cost Implications of Reactive Versus Prospective Testing for Dihydropyrimidine Dehydrogenase Deficiency in Patients With Colorectal Cancer: A Single-Institution Experience. Dose-response : a publication of International Hormesis Society, 16(4), 1559325818803042. https://doi.org/10.1177/1559325818803042

⁽⁵⁾ Dzau, V. J., Ginsburg, G.S., Van Nuys, K., Agus, D., and Goldman, D. (2015). Aligning incentives to fulfill the promise of personalised medicine. Lancet 385(9982):2118-2119. https://doi.org/10.1016/S0140-6736(15)60722- X