Abstract
Novel technologies labelled as 'precision medicine' are targeting all aspects of clinical care. Whilst some technological advances are undeniably exciting, many doctors at the frontline of healthcare view precision medicine as being out of reach for their patients. Computer-guided dosing is a precision medicine technology that predicts drug concentrations and drug responses based on individual patient characteristics. In this opinion piece, the example of computer-guided dosing is used to illustrate eight features of a precision medicine technology less likely to be hyperbole and more likely to improve patient care. Positive features in this regard include: (1) fitting the definition of 'precision medicine'; (2) addressing a major clinical problem that negatively impacts patient care; (3) a track record of high-quality medical science published via peer-reviewed literature; (4) well-defined clinical cases for application; (5) quality evidence of benefits measured by various clinical, patient and health economic endpoints; (6) strong economic drivers; (7) user friendliness, including easy integration into clinical workflow, and (8) recognition of importance by patients and their endorsement for broader clinical use. Barriers raised by critics of the approach are given to balance the view. The value of computer-guided dosing will be decided ultimately by the extent to which it can improve cost-effective patient care.
Highlights
Precision medicine is defined as ‘treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations’[1]
Novel technologies labelled as precision medicine are targeting all aspects of clinical care with the promise of better healthcare for all via better treatment of the individual
Such examples are rare, and a major barrier to computer-guided dosing will be familiarity and acceptance of Decision support tools (DSTs) by everyday prescribers who remain unconvinced of the clinical need
Summary
Precision medicine is defined as ‘treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations’[1]. Many doctors at the frontline of healthcare view precision medicine as merely indulgent fine-tuning for a privileged few rather than a ‘game-changer’ for all In this opinion piece, the example of computer-guided dosing, sometimes called clinical pharmacometrics and/or model-informed precision dosing (MIPD)[4,5], is used to illustrate eight features of a precision medicine technology less likely to be hyperbole and more likely to improve patient care. For precision medicine technologies, knowing which patients, which diseases, and which drugs not to study is as important as knowing which clinical cases to study. An example with high doctor satisfaction is a DST built for busulfan, a narrow therapeutic antineoplastic drug used to prepare pediatric patients for bone marrow transplantation[17] Such examples are rare, and a major barrier to computer-guided dosing will be familiarity and acceptance of DSTs by everyday prescribers who remain unconvinced of the clinical need. There are no published data far on the appeal of computer-guided dosing to patients, so future studies should include endpoints to capture their perspectives[5]
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