title: Economic Evaluation in Stratified Medicine: Methodological Issues and Challenges.
abstract: BACKGROUND
  Stratified Medicine (SM) is becoming a practical reality with the targeting of medicines by using a biomarker or genetic-based diagnostic to identify the eligible patient sub-population. Like any healthcare intervention, SM interventions have costs and consequences that must be considered by reimbursement authorities with limited resources. Methodological standards and guidelines exist for economic evaluations in clinical pharmacology and are an important component for health technology assessments (HTAs) in many countries. However, these guidelines have initially been developed for traditional pharmaceuticals and not for complex interventions with multiple components. This raises the issue as to whether these guidelines are adequate to SM interventions or whether new specific guidance and methodology is needed to avoid inconsistencies and contradictory findings when assessing economic value in SM.
  
  
  OBJECTIVE
  This article describes specific methodological challenges when conducting health economic (HE) evaluations for SM interventions and outlines potential modifications necessary to existing evaluation guidelines /principles that would promote consistent economic evaluations for SM.
  
  
  CONCLUSIONS
  Specific methodological aspects for SM comprise considerations on the choice of comparator, measuring effectiveness and outcomes, appropriate modeling structure and the scope of sensitivity analyses. Although current HE methodology can be applied for SM, greater complexity requires further methodology development and modifications in the guidelines.
authors.affiliation: Department of Pharmacy, University of Gronigen Groningen, Netherlands.
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Fugel
authors.affiliation: ARS Accessus Medica Amsterdam, Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Nuijten
authors.affiliation: Department of Pharmacy, University of Gronigen Groningen, Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Postma
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam Rotterdam, Netherlands.
authors.forename: Ken
authors.initials: K
authors.lastname: Redekop
keywords: biomarkers; guidelines; health technology assessments; reimbursement; reimbursement mechanisms; stratified medicine