The economics of personalized medicine: commercialization as a driver of return on investment

Optimizing commercialization of drugs is the sine qua non of the pharmaceutical industry and intensive work has been done to characterize fully the drivers of drug adoption and understand the resources required to optimize those drivers for full adoption of drugs. Conversely, while the pharmaceutical industry is actively embracing the new personalized medicine (PM) paradigm, much work remains to be done to understand fully what drives adoption of targeted therapies and how to resource those drivers appropriately. While the industry is slowly learning from its early missteps, progress is still inhibited by a lack of understanding of the specific hurdles that individual development teams face in developing and commercializing targeted therapies and the requirement for budgets specifically aimed at driving test adoption. This article considers the benefits of optimizing commercial planning in the PM space and the potential negative impact in potentially failing to optimize that planning. Real world insights are used to illustrate that a far broader commercial lens is required in the PM space and will touch on functional areas not usually included in the context of 'commercial' decisions.     

Maximising return on conservation investment in the conterminous USA

Efficient conservation planning requires knowledge about conservation targets, threats to those targets, costs of conservation and the marginal return to additional conservation efforts. Systematic conservation planning typically only takes a small piece of this complex puzzle into account. Here, we use a return‐on‐investment (ROI) approach to prioritise lands for conservation at the county level in the conterminous USA. Our approach accounts for species richness, county area, the proportion of species' ranges already protected, the threat of land conversion and land costs. Areas selected by a complementarity‐based greedy heuristic using our full ROI approach provided greater averted species losses per dollar spent compared with areas selected by heuristics accounting for richness alone or richness and cost, and avoided acquiring lands not threatened with conversion. In contrast to traditional prioritisation approaches, our results highlight conservation bargains, opportunities to avert the threat of development and places where conservation efforts are currently lacking.     

Proposition 71 and CIRM--assessing the return on investment

Given that Californian voters authorized state coffers to sell $3 billion in bonds to fund the California Institute for Regenerative Medicine (CIRM) with the expectation of health and financial benefits, what benchmarks should be used to measure the initiative's success?     

Protecting biodiversity when money matters: maximizing return on investment

Background

Conventional wisdom identifies biodiversity hotspots as priorities for conservation investment because they capture dense concentrations of species. However, density of species does not necessarily imply conservation ‘efficiency’. Here we explicitly consider conservation efficiency in terms of species protected per dollar invested.

Methodology/Principal Findings

We apply a dynamic return on investment approach to a global biome and compare it with three alternate priority setting approaches and a random allocation of funding. After twenty years of acquiring habitat, the return on investment approach protects between 32% and 69% more species compared to the other priority setting approaches. To correct for potential inefficiencies of protecting the same species multiple times we account for the complementarity of species, protecting up to three times more distinct vertebrate species than alternate approaches.

Conclusions/Significance

Incorporating costs in a return on investment framework expands priorities to include areas not traditionally highlighted as priorities based on conventional irreplaceability and vulnerability approaches.     

An Australian Brain Bank: a critical investment with a high return!

Research into neuropsychiatric disorders, including alcohol-related problems, is limited in part by the lack of appropriate animal models. However, the development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. The New South Wales Tissue Resource Centre (TRC) in the University of Sydney (Australia) is a human brain bank that can provide tissues to the neuroscience research community studying alcohol-related brain disorders, schizophrenia, depression and bipolar disorders. Carefully standardised operational protocols and integrated information systems means that the TRC can provide high quality, accurately characterised, tissues for research. A recent initiative, the pre-mortem donor program called "Using our Brains", encourages individuals without neuropsychiatric illness to register as control donors, a critical group for all research. Community support for this program is strong with over 2,000 people registering their interest. Discussed herein are the protocols pertaining to this multifaceted facility and the benefits of investment, both scientific and financial, to neuroscience researchers and the community at large.     

Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence

Background

Approximately 50% of smokers die prematurely from tobacco-related diseases. In July 2006, the Massachusetts health care reform law mandated tobacco cessation coverage for the Massachusetts Medicaid population. The new benefit included behavioral counseling and all medications approved for tobacco cessation treatment by the U.S. Food and Drug Administration (FDA). Between July 1, 2006 and December 31, 2008, a total of 70,140 unique Massachusetts Medicaid subscribers used the newly available benefit, which is approximately 37% of all Massachusetts Medicaid smokers. Given the high utilization rate, the objective of this study is to determine if smoking prevalence decreased significantly after the initiation of tobacco cessation coverage.

Methods and Findings

Smoking prevalence was evaluated pre- to post-benefit using 1999 through 2008 data from the Massachusetts Behavioral Risk Factor Survey (BRFSS). The crude smoking rate decreased from 38.3% (95% C.I. 33.6%–42.9%) in the pre-benefit period compared to 28.3% (95% C.I.: 24.0%–32.7%) in the post-benefit period, representing a decline of 26 percent. A demographically adjusted smoking rate showed a similar decrease in the post-benefit period. Trend analyses reflected prevalence decreases that accrued over time. Specifically, a joinpoint analysis of smoking prevalence among Massachusetts Medicaid benefit-eligible members (age 18–64) from 1999 through 2008 found a decreasing trend that was coincident with the implementation of the benefit. Finally, a logistic regression that controlled for demographic factors also showed that the trend in smoking decreased significantly from July 1, 2006 to December 31, 2008.

Conclusion

These findings suggest that a tobacco cessation benefit that includes coverage for medications and behavioral treatments, has few barriers to access, and involves broad promotion can significantly reduce smoking prevalence.     

Lifetime return on investment increases with leaf lifespan among 10 Australian woodland species

? Co-occurring species often differ in their leaf lifespan (LL) and it remains unclear how such variation is maintained in a competitive context. Here we test the hypothesis that leaves of long-LL species yield a greater return in carbon (C) fixed per unit C or nutrient invested by the plant than those of short-LL species. ? For 10 sympatric woodland species, we assessed three-dimensional shoot architecture, canopy openness, leaf photosynthetic light response, leaf dark respiration and leaf construction costs across leaf age sequences. We then used the YPLANT model to estimate light interception and C revenue along the measured leaf age sequences. This was done under a series of simulations that incorporated the potential covariates of LL in an additive fashion. ? Lifetime return in C fixed per unit C, N or P invested increased with LL in all simulations. ? In contrast to other recent studies, our results show that extended LL confers a fundamental economic advantage by increasing a plant's return on investment in leaves. This suggests that time-discounting effects, that is, the compounding of income that arises from quick reinvestment of C revenue, are key in allowing short-LL species to succeed in the face of this economic handicap.     

Participation of Colorado pediatricians and family physicians in the Medicaid program.

The Pediatric Health Policy Group of the University of Colorado Health Sciences Center (Denver) surveyed 650 family physicians and 296 pediatricians in 1988, with 50% of family physicians and 48% of pediatricians responding. Half of the pediatricians in private practice and 35% of family physicians in private practice accepted all children who were Medicaid beneficiaries into their practice; 42% of pediatricians and 50% of family physicians accepted all non-Medicaid patients but only some new Medicaid patients; and 8% of pediatricians and 15% of family physicians accepted new non-Medicaid patients but no Medicaid patients. Practice location was associated with the level of Medicaid participation for these primary care physicians: Significantly more rural pediatricians and family physicians than those with urban practices accepted Medicaid patients. The average reimbursement level for these physicians was shown to be an important determinant of whether physicians would accept Medicaid patients. Nonparticipatory physicians were more concerned about excessive paperwork compared with physicians with limited participation. Among physicians with limited participation, family physicians and pediatricians both cited problems of excessive paperwork, reimbursement delays, and retroactive denials of payment as important deterrents to accepting Medicaid patients.     

What to do in the face of multiple threats? Incorporating dependencies within a return on investment framework for conservation

Aim Our study aimed to determine priority areas for conservation investment with explicit consideration of the impacts of multiple threatening processes, and the dependencies that exist between actions required to abate these threats. Location Australia. Methods We analysed the return on investment for two different management actions aimed at reducing the impact of invasive species on the native fauna and flora of Australia. We focussed on the management of the European red fox (Vulpes vulpes) and European rabbit (Oryctolagus cuniculus) at two spatial scales: across 72 biogeographic regions of Australia and within one high‐priority biogeographic region. We considered each action independently and also explicitly accounted for the option of an integrated fox and rabbit management action. We accounted for the spatial distributions of the threatened species within our analysis and determined how this refined spatial information influenced both the priority areas and the timing of this investment. Results Integrated fox and rabbit management was identified as a higher priority than singular threat abatement in most bioregions, whereas rabbit control alone was the most frequent priority if dependencies between actions were ignored. At the regional scale, funding was entirely directed to integrated action when seven or more species within the priority region were impacted by more than one threat. The total allocation of funding and timing of initial investment remained relatively insensitive to differences in the spatial overlap of species distributions. Main conclusions Our findings indicate that prioritizing conservation actions without explicit consideration of the impacts of multiple threats can reduce the cost‐effectiveness of investments. The benefits expected from investment in abating one threat alone may be overestimated where other processes continue to threaten species persistence. We conclude that future attention should be directed to refining our understanding of the cost‐efficiencies delivered through integrated actions and institutional mechanisms to achieve their delivery.     

Effect of the California tobacco control program on personal health care expenditures

Background

Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California''s large-scale tobacco control program on aggregate personal health care expenditures in the state.

Methods and Findings

Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004.

Conclusions

A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.     

A screening strategy for heterologous protein expression in Escherichia coli with the highest return of investment

Heterologous protein expression in Escherichia coli is commonly used to obtain recombinant proteins for a variety of downstream applications. However, many proteins are not, or are only poorly, expressed in soluble form. High level expression often leads to the formation of inclusion bodies and an inactive product that needs to be refolded. By screening the solubility pattern for a set of 71 target proteins in different host-strains and varying parameters such as location of purification tag, promoter and induction temperature we propose a protocol with a success rate of 77% of clones returning a soluble protein. This protocol is particularly suitable for high-throughput screening with the goal to obtain soluble protein product for e.g. structure determination.     

The cessation of gastrulation

An integral component of gastrulation in all organisms is epithelial-mesenchymal transition (EMT), a fundamental morphogenetic event through which epithelial cells transform into mesenchymal cells. The mesenchymal cells that arise from epithelial cells during gastrulation contribute to various tissue rudiments during subsequent development, including the notochord, somites, heart, gut, kidney, body wall, and lining of the coelom. The process of gastrulation has been the subject of several hundred scientific papers. Despite all that has been written, it is likely that what we currently know about gastrulation is still considerably less than what remains to be learned. One critical remaining question that we consider here is how does gastrulation cease at the right place along the body axis, and at the right time? In this commentary, we focus on the molecular mechanism for the cessation of gastrulation, using the chick embryo as a model system.     

The return of sleep

While most individuals spend a substantial amount of time sleeping, Japan is among the developed countries whose residents register the fewest number of hours of sleep. I thus examine the causal effects of sleep on labor productivity, utilizing panel datasets for Japanese men. The potential endogeneity of deciding how many hours to sleep is addressed by using fixed effects panel data models with an instrumental variable estimation technique. Exploiting the annual variation in the average sunshine duration between cities as an instrument, I then show that a one-hour increase in the weekly number of hours of sleep increases the wage rate by up to 6–8% on average. These results suggest that sleep duration could enhance labor productivity.