Abstract
PurposeThis study explored health insurance coverage of genetic testing and potential factors associated with precision medicine (PM) reimbursement in Thailand.Design/methodology/approachThe study employed a targeted review method. Thirteen PMs were selected to represent four PM categories: targeted cancer therapy candidate, prediction of adverse drug reactions (ADRs), dose adjustment and cancer risk prediction. Content analysis was performed to compare access to PMs among three health insurance schemes in Thailand. The primary outcome of the study was evaluating PM test reimbursement status. Secondary outcomes included clinical practice guidelines, PMs statement in FDA-approved leaflet and economic evaluation.FindingsCivil Servant Medical Benefits Scheme (CSMBS) provided more generous access to PM than Universal Coverage Scheme (UCS) and Social Security Scheme (SSS). Evidence of economic evaluations likely impacted the reimbursement decisions of SSS and UCS, while the information provided in FDA-approved leaflets seemed to impact the reimbursement decisions of CSMBS. Three health insurance schemes provided adequate access to PM tests for some cancer-targeted therapies, while gaps existed for access to PM tests for serious ADRs prevention, dose adjustment and cancer risk prediction.Originality/valueThis was the first study to explore the situation of access to PMs in Thailand. The evidence alerts public health insurance schemes to reconsider access to PMs. Development of health technology assessment guidelines for PM test reimbursement decisions should be prioritized.
Highlights
Precision medicine (PM) is an approach to accurately select treatments or preventive measures based on the individual patient’s genetic information
The framework of this study was adapted from Meckley and Neumann [7], which was composed of four variables: PM test reimbursement status, genetic test mentioning in clinical practice guidelines, genetic test information in drug labeling and value for money of the genetic test
The study showed that there was a discrepancy in access to PMs among the three public health insurance schemes in Thailand
Summary
Precision medicine (PM) is an approach to accurately select treatments or preventive measures based on the individual patient’s genetic information. The human genome project was first initiated in 1990 [1]. The knowledge in this field has greatly expanded. The Precision Medicine Coalition reported that the market authorization of genetic testing has sharply increased during the past decade [2]. As of 2019, there were more than 187 biomarkers for 377 companion drug items registered with the US FDA [3, 4]. Knowledge about PM has been very well established for years, the adoption of PMs in clinical practice is still limited in many countries [5, 6]
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