The healthcare industry is changing rapidly thanks to digital technologies. The application of these technologies through personalised medicine (PM), which tailors healthcare delivery to individual needs, could help health systems (including those in the GCC) improve outcomes and patient experiences, while controlling treatment costs. As they take their first steps in PM, GCC countries should examine the experience of healthcare systems in developed economies in this field.
Current medicine mainly uses a one-size-fits-all approach for diagnostics and prescriptions. This means 90 per cent of conventional medicines work only for 30-50 per cent of patients. Current medicine struggles with the complexity of an individual’s needs and is unsatisfying to patients who regard themselves as consumers.
By contrast, PM works case-by-case, focusing on each patient individually to develop treatments and therapies. PM achieves this by exploiting data relating to a patient’s life and risk profile, medical records, health history, and genome. In recent years, technologies such as AI, big data, machine learning, and direct-to-consumer kits have made it easier to extract genomic information.
With this information, PM can have significant health and financial impacts. Patients only receive the treatments that are appropriate for them, leading to lower treatment costs, fewer complications or unexpected side effects, and reduced risk of relapses. For example, the KRAS gene controls cell proliferation, with mutations leading to cancer. Such mutations occur in about 40 per cent of colorectal cancers.
Testing patients for such mutations leads to more effective treatment. Indeed, by using PM the five-year survival rates for several cancers have increased: by up to 58 per cent for myeloid leukemia and 15 per cent for colorectal cancer.
A core element of PM is genomic testing, which identifies conditions that benefit from early intervention or lifestyle changes. Such testing can inform people that they are pre-diabetic, encouraging them to change their diet and become more active. For example, US-based Genoma International’s genomic wellness programme helped companies improve the health outcomes of employees with chronic diseases while reducing healthcare costs by 20 per cent annually, through lower direct healthcare costs and indirect costs from sick days and poor productivity.
Already there is a move toward PM. According to Strategy&, 84 per cent of pharmaceutical companies have PM in their plans. The Tufts Center for the Study of Drug Development reported in 2015 that pharmaceutical companies could modify 42 per cent of medicines in their pipelines to become PMs.
The French government’s plan for genomic medicine 2025 is investing Eur670m ($757m) in sequencing platforms, with centres for expertise and analysis for data and platform maintenance. In the US, Aspire Universal and Penn Medicine Lancaster General Health have launched a $300m fund for precision medicine technologies that use artificial intelligence and the Internet of Things. The projections are that PM could grow 11 per cent per year from 2020 to 2026, and be worth $142bn globally.
GCC countries already recognise PM’s importance. The King Faisal Specialist Hospital and Research Centre in Saudi Arabia has established genomics research. Others are expected to follow. However, GCC countries need to overcome the same obstacles as developed economies have faced around finance, regulations, and people.
Financially, the challenge is that reimbursement coverage remains limited. Payers, insurance companies and social insurance, require evidence on clinical utility, which PM cannot justify easily. GCC healthcare stakeholders could invest in start-ups that provide promising PM applications.
Regulations unfortunately have not kept pace with advances in PM, and they demand complex and expensive compliance. Patent laws remain unfavourable to innovators. Similarly, testing and approvals generally use aggregate comparative mechanisms that do not work well with PM’s tailored approach.
Regulators should update their frameworks, starting with streamlined approvals and a more flexible approach, increased availability of data, and dedicated government R&D funding. The healthcare regulatory framework should attract research facilities and biopharmaceutical companies to the GCC and grow their PM offering.
There are also too few people with the skill set for the sophisticated correlative analysis of biomarkers and genomic data – skills spanning pharmaceuticals, genetics, and data analytics. Private companies could retrain physicians and laboratory staff to interpret genomic data, taking advantage of partnerships across the ecosystem.
PM is likely to dominate healthcare systems of the future. If GCC countries take action now to remove the financial, regulatory, and human capital obstacles, then the region could become a testing ground and, eventually, a hub for PM.
Walid Tohme is a partner with Strategy&, and head of the firm’s Health practice in the Middle East