Modeling the economic equity of precision oncology
Abstract
References
- Adeniji, A. A., Dulal, S., & Martin, M. G. (2021). Personalized Medicine in Oncology in the Developing World: Barriers and Concepts to Improve Status Quo. World journal of oncology, 12(2-3), 50–60. https://doi.org/10.14740/wjon1345
- AlDoughaim, M., AlSuhebany, N., AlZahrani, M., AlQahtani, T., AlGhamdi, S., Badreldin, H., & Al Alshaykh, H. (2024). Cancer Biomarkers and Precision Oncology: A Review of Recent Trends and Innovations. Clinical Medicine Insights. Oncology, 18, 11795549241298541. https://doi.org/10.1177/11795549241298541
- American Association of Cancer Research (2025), Cancer in 2025, Available from https://cancerprogressreport.aacr.org/progress/cpr25-contents/cpr25-cancer-in-2025/. Accessed October 5th, 2025.
- Barragan-Carillo, R., Asirwa, F. C., Dienstmann, R., Pendhakar, D., & Ruiz-Garcia, E. (2025). Global Oncology: Tackling Disparities and Promoting Innovations in Low- and Middle-Income Countries. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 45(3), e473930. https://doi.org/10.1200/EDBK-25-473930
- Barrios, C., de Lima Lopes, G., Yusof, M. M., Rubagumya, F., Rutkowski, P., & Sengar, M. (2023). Barriers in access to oncology drugs - a global crisis. Nature reviews. Clinical oncology, 20(1), 7–15. https://doi.org/10.1038/s41571-022-00700-7
- Basnayake Ralalage, P., Mitchell, T., Zammit, C., Baynam, G., Kowal, E., Masey, L., McGaughran, J., Boughtwood, T., Jenkins, M., Pratt, G., & Ferdinand, A. (2024). "Equity" in genomic health policies: a review of policies in the international arena. Frontiers in public health, 12, 1464701. https://doi.org/10.3389/fpubh.2024.1464701
- Bognar, C. L. F. B., Bychkovsky, B. L., & Lopes, G. L., Jr (2016). Compulsory Licenses for Cancer Drugs: Does Circumventing Patent Rights Improve Access to Oncology Medications?. Journal of global oncology, 2(5), 292–301. https://doi.org/10.1200/JGO.2016.005363
- Bourke, M., McInerney-Leo, A., Steinberg, J., Boughtwood, T., Milch, V., Ross, A. L., Ambrosino, E., Dalziel, K., Franchini, F., Huang, L., Peters, R., Gonzalez, F. S., & Goranitis, I. (2025). The Cost Effectiveness of Genomic Medicine in Cancer Control: A Systematic Literature Review. Applied health economics and health policy, 23(3), 359–393. https://doi.org/10.1007/s40258-025-00949-w
- Cheung, A. T. M., Palapattu, E. L., Pompa, I. R., Aldrighetti, C. M., Niemierko, A., Willers, H., Huang, F., Vapiwala, N., Van Allen, E., & Kamran, S. C. (2023). Racial and ethnic disparities in a real-world precision oncology data registry. NPJ precision oncology, 7(1), 7. https://doi.org/10.1038/s41698-023-00351-6
- Christofyllakis, K., Bittenbring, J. T., Thurner, L., Ahlgrimm, M., Stilgenbauer, S., Bewarder, M., & Kaddu-Mulindwa, D. (2022). Cost-effectiveness of precision cancer medicine-current challenges in the use of next generation sequencing for comprehensive tumour genomic profiling and the role of clinical utility frameworks (Review). Molecular and clinical oncology, 16(1), 21. https://doi.org/10.3892/mco.2021.2453
- Cookson, R., Griffin, S., Norheim, O. F., & Culyer, A. J. (Eds.). (2020). Distributional cost-effectiveness analysis: quantifying health equity impacts and trade-offs. Oxford University Press.
- Cookson, R., Mirelman, A. J., Griffin, S., Asaria, M., Dawkins, B., Norheim, O. F., Verguet, S., & J Culyer, A. (2017). Using Cost-Effectiveness Analysis to Address Health Equity Concerns. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 20(2), 206–212. https://doi.org/10.1016/j.jval.2016.11.027
- Coughlin, S. S., Clary, C., Johnson, J. A., Berman, A., Heboyan, V., Benevides, T., Moore, J., & George, V. (2019). Continuing Challenges in Rural Health in the United States. Journal of environment and health sciences, 5(2), 90–92. https://pmc.ncbi.nlm.nih.gov/articles/PMC7043306/
- Dawkins, B., Shinkins, B., Ensor, T., Jayne, D., & Meads, D. (2024). Incorporating healthcare access and equity in economic evaluations: a scoping review of guidelines. International journal of technology assessment in health care, 40(1), e59. https://doi.org/10.1017/S0266462324000618
- Dowell, E.M., Wang, D.H. (2023) Health Disparities and Precision Oncology in Foregut Malignancies. Foregut: The Journal of the American Foregut Society, 3(2):227-234. doi:10.1177/26345161231170660
- Esdaille, A. R., Ibilibor, C., Holmes, A., 2nd, Palmer, N. R., & Murphy, A. B. (2022). Access and Representation: A Narrative Review of the Disparities in Access to Clinical Trials and Precision Oncology in Black men with Prostate Cancer. Urology, 163, 90–98. https://doi.org/10.1016/j.urology.2021.09.004
- Francis, T., Teshome, B., Stanimirovic, A., & Rac, V. E. (2025). Application of distributional cost-effectiveness analysis methodology in real-world studies: a scoping review protocol. BMJ open, 15(5), e099673. https://doi.org/10.1136/bmjopen-2025-099673
- Francisco, K. K. Y., Apuhin, A. E. C., Maravilla, N. M. A. T., Byers, M. C., Karim, H. A., Tan, M. J. T., & AlDahoul, N. (2025). Personalized medicine and health equity: overcoming cost barriers and ethical challenges. International journal for equity in health, 25(1), 4. https://doi.org/10.1186/s12939-025-02710-0
- Gerido, L. H., & Ayday, E. (2024). An Ethical Approach to Genomic Privacy Preserving Technology Development. Proceedings. IEEE International Conference on Healthcare Informatics, 2024, 638–641. https://doi.org/10.1109/ichi61247.2024.00102
- Gardner, B., Doose, M., Sanchez, J. I., Freedman, A. N., & de Moor, J. S. (2021). Distribution of Genomic Testing Resources by Oncology Practice and Rurality: A Nationally Representative Study. JCO precision oncology, 5, PO.21.00109. https://doi.org/10.1200/PO.21.00109
- Granados Moreno, P., Joly, Y., & Knoppers, B. M. (2017). Public-Private Partnerships in Cloud-Computing Services in the Context of Genomic Research. Frontiers in medicine, 4, 3. https://doi.org/10.3389/fmed.2017.00003
- Haslem, D. S., Chakravarty, I., Fulde, G., Gilbert, H., Tudor, B. P., Lin, K., Ford, J. M., & Nadauld, L. D. (2018). Precision oncology in advanced cancer patients improves overall survival with lower weekly healthcare costs. Oncotarget, 9(15), 12316–12322. https://doi.org/10.18632/oncotarget.24384
- Henkel, P. S., Aas, E., Russnes, H. G., Dyvik, I., Fagereng, G. L., Helland, Å., Røgenes, H., Lien, T. G., & Pedersen, K. (2025). Microcosting Study of Genomic Profiling for Precision Cancer Medicine: Application from the National Infrastructure for Precision Diagnostics in Norway. The Journal of molecular diagnostics : JMD, 27(10), 945–953. https://doi.org/10.1016/j.jmoldx.2025.06.006
- Jallah, J. K., Dweh, T. J., Anjankar, A., & Palma, O. (2023). A Review of the Advancements in Targeted Therapies for Breast Cancer. Cureus, 15(10), e47847. https://doi.org/10.7759/cureus.47847
- Jayasundara, K., Krahn, M., Mamdani, M., Hoch, J. S., & Grootendorst, P. (2017). Differences in Incremental Cost-Effectiveness Ratios for Common Versus Rare Conditions: A Case from Oncology. PharmacoEconomics - open, 1(3), 167–173. https://doi.org/10.1007/s41669-017-0022-7
- Karabekmez M. E. (2021). Data Ethics in Digital Health and Genomics. The New bioethics : a multidisciplinary journal of biotechnology and the body, 27(4), 320–333. https://doi.org/10.1080/20502877.2021.1996965
- Kasztura, M., Richard, A., Bempong, N. E., Loncar, D., & Flahault, A. (2019). Cost-effectiveness of precision medicine: a scoping review. International journal of public health, 64(9), 1261–1271. https://doi.org/10.1007/s00038-019-01298-x
- Lakdawalla, D. N., & Malani, A. (2015). Health technology assessment and equity: A new frontier. Journal of Health Economics, 43, 85–90. https://pubmed.ncbi.nlm.nih.gov/32592923/
- Love-Koh, J., Peel, A., Rejon-Parrilla, J. C., Ennis, K., Lovett, R., Manca, A., Chalkidou, A., Wood, H., & Taylor, M. (2018). The Future of Precision Medicine: Potential Impacts for Health Technology Assessment. PharmacoEconomics, 36(12), 1439–1451. https://doi.org/10.1007/s40273-018-0686-6
- Mapendano, C. K., Nøhr, A. K., Sønderkær, M., Pagh, A., Carus, A., Lörincz, T., Haslund, C. A., Poulsen, L. Ø., Ernst, A., Bødker, J. S., Dahl, S. C., Sunde, L., Brügmann, A. H., Vesteghem, C., Pedersen, I. S., & Ladekarl, M. (2025). Longer survival with precision medicine in late-stage cancer patients. ESMO open, 10(1), 104089. https://doi.org/10.1016/j.esmoop.2024.104089
- Marquart, J., Chen, E. Y., & Prasad, V. (2018). Estimation of the Percentage of US Patients With Cancer Who Benefit From Genome-Driven Oncology. JAMA oncology, 4(8), 1093–1098. https://doi.org/10.1001/jamaoncol.2018.1660
- Martinez-Martin, N., & Magnus, D. (2019). Privacy and ethical challenges in next-generation sequencing. Expert review of precision medicine and drug development, 4(2), 95–104. https://doi.org/10.1080/23808993.2019.1599685
- Meunier, A., Longworth, L., Gomes, M., Ramagopalan, S., Garrison, L. P., & Popat, S. (2023). Distributional Cost-Effectiveness Analysis of Treatments for Non-Small Cell Lung Cancer: An Illustration of an Aggregate Analysis and its Key Drivers. PharmacoEconomics, 41(8), 1011–1025. https://doi.org/10.1007/s40273-023-01281-8
- Normanno, N., Apostolidis, K., Wolf, A., Al Dieri, R., Deans, Z., Fairley, J., Maas, J., Martinez, A., Moch, H., Nielsen, S., Pilz, T., Rouleau, E., Patton, S., & Williams, V. (2022). Access and quality of biomarker testing for precision oncology in Europe. European journal of cancer (Oxford, England : 1990), 176, 70–77. https://doi.org/10.1016/j.ejca.2022.09.005
- Owens, C. E. L., Tan, O., Kuroiwa-Trzmielina, J., Shrestha, R. N., O'Brien, T., Tyrrell, V., & Schofield, D. J. (2024). The economic costs of precision medicine for clinical translational research among children with high-risk cancer. NPJ precision oncology, 8(1), 224. https://doi.org/10.1038/s41698-024-00711-w
- Pacifico Silva, H., Lehoux, P., Miller, F. A., & Denis, J. L. (2018). Introducing responsible innovation in health: a policy-oriented framework. Health research policy and systems, 16(1), 90. https://doi.org/10.1186/s12961-018-0362-5
- Peebles, I. S., Kinney, D. B., & Foster-Hanson, E. (2024). Systematic decision frameworks for the socially responsible use of precision medicine. NPJ genomic medicine, 9(1), 46. https://doi.org/10.1038/s41525-024-00433-9
- Phillips, K. A., Trosman, J. R., Douglas, M. P., Gelb, B. D., Ferket, B. S., Hindorff, L. A., Slavotinek, A. M., Berg, J. S., Russell, H. V., Devine, B., Greve, V., & Smith, H. S. (2022). US private payers' perspectives on insurance coverage for genome sequencing versus exome sequencing: A study by the Clinical Sequencing Evidence-Generating Research Consortium (CSER). Genetics in medicine : official journal of the American College of Medical Genetics, 24(1), 238–244. https://doi.org/10.1016/j.gim.2021.08.009
- Punian, J., Ehman, M., Weymann, D., & Regier, D. A. (2025). A scoping review of the cost-effectiveness of precision treatment in chronic lymphocytic leukemia. Personalized medicine, 22(5), 325–335. https://doi.org/10.1080/17410541.2025.2535276
- Radich, J. P., Briercheck, E., Chiu, D. T., Menon, M. P., Sala Torra, O., Yeung, C. C. S., & Warren, E. H. (2022). Precision Medicine in Low- and Middle-Income Countries. Annual review of pathology, 17, 387–402. https://doi.org/10.1146/annurev-pathol-042320-034052
- Ringborg, U., von Braun, J., Celis, J., Baumann, M., Berns, A., Eggermont, A., Heard, E., Heitor, M., Chandy, M., Chen, C. J., Costa, A., De Lorenzo, F., De Robertis, E. M., Dubee, F. C., Ernberg, I., Gabriel, M., Helland, Å., Henrique, R., Jönsson, B., Kallioniemi, O., … Yang, H. (2024). Strategies to decrease inequalities in cancer therapeutics, care and prevention: Proceedings on a conference organized by the Pontifical Academy of Sciences and the European Academy of Cancer Sciences, Vatican City, February 23-24, 2023. Molecular oncology, 18(2), 245–279. https://doi.org/10.1002/1878-0261.13575
- Saulsberry, L., & Olopade, O. I. (2021). Precision oncology: Directing genomics and pharmacogenomics toward reducing cancer inequities. Cancer cell, 39(6), 730–733. https://doi.org/10.1016/j.ccell.2021.04.013
- Shafrin, J., Kim, J., Cohen, J. T., Garrison, L. P., Goldman, D. A., Doshi, J. A., Krieger, J., Lakdawalla, D. N., Neumann, P. J., Phelps, C. E., Whittington, M. D., & Willke, R. (2024). Valuing the Societal Impact of Medicines and Other Health Technologies: A User Guide to Current Best Practices. Forum for health economics & policy, 27(1), 29–116. https://doi.org/10.1515/fhep-2024-0014
- Smith, H. S., Buchanan, J., Goranitis, I., IJzerman, M. J., Lavelle, T. A., Marshall, D. A., Regier, D. A., Ungar, W. J., Weymann, D., Wordsworth, S., Phillips, K. A., & Jansen, J. P. (2025). Distributional Cost-Effectiveness Analysis in Genomic Medicine: Considerations for Addressing Health Equity. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 28(8), 1213–1220. https://doi.org/10.1016/j.jval.2025.04.2162
- Tfayli, A. H., El-Halabi, L. N., & Khuri, F. R. (2025). Global disparities in cancer care: Bridging the gap in affordability and access to medications between high and low-income countries. Cancer, 131(1), e35590. https://doi.org/10.1002/cncr.35590
- Tsimberidou, A. M., Fountzilas, E., Nikanjam, M., & Kurzrock, R. (2020). Review of precision cancer medicine: Evolution of the treatment paradigm. Cancer treatment reviews, 86, 102019. https://doi.org/10.1016/j.ctrv.2020.102019
- Yabroff, K. R., Sylvia Shi, K., Zhao, J., Freedman, A. N., Zheng, Z., Nogueira, L., Han, X., Klabunde, C. N., & de Moor, J. S. (2024). Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions. JCO oncology practice, 20(3), 429–437. https://doi.org/10.1200/OP.23.00153
- Yerramilli, P., Chopra, M., & Rasanathan, K. (2024). The cost of inaction on health equity and its social determinants. BMJ global health, 9(Suppl 1), e012690. https://doi.org/10.1136/bmjgh-2023-012690
- Zhao, Y., Dimou, A., Fogarty, Z. C., Jiang, J., Liu, H., Wong, W. B., & Wang, C. (2024). Real-world Trends, Rural-urban Differences, and Socioeconomic Disparities in Utilization of Narrow versus Broad Next-generation Sequencing Panels. Cancer research communications, 4(2), 303–311. https://doi.org/10.1158/2767-9764.CRC-23-0190
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