Personalised Medicine in shaping sustainable healthcare: a Delphi survey within the IC2PerMed project

Abstract Background Personalised medicine (PM) has the potential to transform health systems and make them more sustainable, by making the population healthier and allocating resources efficiently. European Union and China have become world leaders in the field of PM, increasing collaborations worldwide. In this context, the EU Commission in 2020 launched the IC2PerMed (Integrating China in the International Consortium for Personalised Medicine) project to provide key solutions to enable the convergence of European and Chinese stakeholders toward a common approach in PM. Methods From a mapping exercise of policies and programs in PM in EU and China, we identified 20 priority items for shaping sustainable healthcare. Such items were submitted to several Chinese and European experts in PM involved in a 3-round Delphi survey. Experts were asked to review the items’ content and rate their validity and relevance on a 5-point Likert scale. Priorities reaching a Content Validity Index of more than 79% were included, between 70 and 79% were revised, and less than 70% were excluded. Results Of 20 priorities submitted, 9 reached consensus. The priorities hinge on the resources allocation, defining in advance priority investment, and identifying new payment models for public reimbursement, health technology impact, and assessment importance, while integrating end-user perceptions into the whole innovation process. In addition, the pivotal role of multidisciplinary and cross-sectorial collaborations emerged. Ethical, legal, and social implications and the related costs should be always considered in policymaking, evaluation, and management of technological innovation. Conclusions Integrating resources and setting a clear agenda for the implementation of PM would lead to a faster and more efficient translation into clinical practice. Developing policies valuing all the stakeholders’ contributions would implement PM adoption. Key messages • Healthcare systems sustainability is a priority and PM could make the population healthier and help allocate resources more efficiently, hence reducing the overall costs of healthcare. • The inter-sectoral collaborations in healthcare are fundamental to achieving the best standard of care. All stakeholders and policymakers should engage to foster sustainability.


Background:
Up to 7% of the Swedish population meets criteria for harmful use or alcohol dependency but only 10-20% seek treatment. One of the most recommended psychological treatments for controlled drinking is Motivational Enhancement Therapy (MET). Behavioural Self-Control Training (BSCT) is another treatment that is unique in that it is based on the psychology of learning and specifically focused on skills training. To our knowledge, no previous studies exist that evaluated the costeffectiveness of BSCT for alcohol use disorders (AUD). The aim of this study is to assess the cost-effectiveness of BSCT compared to MET for patients with AUD aiming for controlled drinking over the longer-term from a societal perspective.

Methods:
We modelled a cohort of patients with AUD who aim for controlled drinking, over a 10 year time horizon, and estimated the expected costs and outcomes of BSCT and MET. The model reflects the epidemiological transitions between drinking states, which reflect different levels of daily alcohol intake. Each drinking state is connected to temporary or long-term complications attributable to alcohol consumption, different costs and utilities. The data was sourced from a randomized trial evaluating the effectiveness of MET vs BSCT. Risks for complications and associated costs, utilities and mortality were sourced from the literature.

Conclusions:
This study suggests that MET should remain the recommended treatment for AUD patients with a goal of controlled drinking in favor of BSCT.

Key messages:
Motivational Enhancement Therapy should remain the recommended treatment for AUD patients with controlled drinking as their goal. A future study comparing Motivational Enhancemente Therapy to Behaivoral Self Control Training as recommended treatment in patients wanting to achieve abstinenece is suggested.

Background:
Personalised medicine (PM) has the potential to transform health systems and make them more sustainable, by making the population healthier and allocating resources efficiently. European Union and China have become world leaders in the field of PM, increasing collaborations worldwide. In this context, the EU Commission in 2020 launched the IC2PerMed (Integrating China in the International Consortium for Personalised Medicine) project to provide key solutions to enable the convergence of European and Chinese stakeholders toward a common approach in PM.

Methods:
From a mapping exercise of policies and programs in PM in EU and China, we identified 20 priority items for shaping sustainable healthcare. Such items were submitted to several Chinese and European experts in PM involved in a 3-round Delphi survey. Experts were asked to review the items' content and rate their validity and relevance on a 5-point Likert scale. Priorities reaching a Content Validity Index of more than 79% were included, between 70 and 79% were revised, and less than 70% were excluded.

Results:
Of 20 priorities submitted, 9 reached consensus. The priorities hinge on the resources allocation, defining in advance priority investment, and identifying new payment models for public reimbursement, health technology impact, and assessment importance, while integrating end-user perceptions into the whole innovation process. In addition, the pivotal role of multidisciplinary and cross-sectorial collaborations emerged. Ethical, legal, and social implications and the related costs should be always considered in policymaking, evaluation, and management of technological innovation.

Conclusions:
Integrating resources and setting a clear agenda for the implementation of PM would lead to a faster and more efficient translation into clinical practice. Developing policies valuing all the stakeholders' contributions would implement PM adoption.

Key messages:
Healthcare systems sustainability is a priority and PM could make the population healthier and help allocate resources more efficiently, hence reducing the overall costs of healthcare.

Background:
Previous studies allowed defining a novel checklist for the participatory evaluation of person-centredness in hospital care using 243 items, grouped in 4 main areas, 12 sub-areas and 29 criteria. We aimed to validate a reduced set of core items that could be continuously used for service improvement in Italy.

Methods:
Validation was performed using data collected during the last national survey carried out in 2017-2018 in N = 387 acute care hospitals from 16 out of 21 Italian regions. Descriptive measures for each item were used to assess eligibility for factor analysis, applied separately on each of the 4 main areas originally identified. Varimax rotation with eigenvalues>1 was used to optimise factor structure. Items with an item-total correlation>0.30 and factor loadings>0.4 were attributed to individual factors. Items with inter-item correlation coeffi-cient>0.70 were included in a list of candidate mergers, submitted to expert opinion. Cronbach's alpha was used to assess overall internal consistency.

Results:
A total of 183 out of 243 items included in the original checklist were submitted to factor analysis. Overall values of Cronbach's alpha ranged between 0.77-0.90, indicating a high consistency. A total of 67 items were finally attributed to 4 main areas, allocated as follows: 16 items in 4 sub-areas for 'Person-oriented organisational and care processes', 16 items in 4 sub-areas for 'Physical accessibility, livability and comfort of the facilities', 15 items in 3 sub-areas for 'Access to information, streamlining and transparency', and 20 items in 4 sub-areas for 'Taking care of the relationship with patients and citizens'.

Conclusions:
A simplified checklist including a manageable number of items that can be easily managed to evaluate hospital services was identified through an objective validation process. The national experience can provide valuable lessons for the application of participatory approaches of person-centred care.

Key messages:
A standardised checklist has been validated using survey data collected through a participatory process in Italian regions. The checklist can be used to evaluate and improve personcentered hospital services through a manageable number of items and factors. Background: Epidemiological measures such as incidence, prevalence, or deaths are essential for monitoring population health. However, evaluating them in isolation cannot adequately compare and assess the relative importance of different diseases. Assessments of the burden of disease (BoD) are therefore of growing importance in supporting health policy decisions. Using disability-adjusted life years (DALY) as a summary measure of population health, BoD integrates morbidity and mortality in a transparent approach.

Methods:
Within BoD methodology, deviations in the health of the population from an 'ideal' health status is quantified in the unit of life years. DALY are the sum of years of life lost due to death (YLL) and years lived with disability (YLD). While YLL describe the gap between age at death and statistical life expectancy, the indicator YLD quantifies years lived with a disability or disease. Calculations were based on different primary and secondary data sources for Germany, especially cause-of-death statistics, epidemiological survey data, and statutory health insurance data.

Results:
In Germany, there were about 12 million DALY in 2017, the equivalent of 14,584 DALY per 100,000 population. Coronary heart disease contributes the most to the overall burden of disease, followed by lower back pain and lung cancer. In women, headache disorders and dementias account for more DALY as compared to men. Men have a higher burden of disease from lung cancer or alcohol use disorders. Pain disorders and alcohol use disorders lead the DALY rankings for both sexes in younger adulthood. The burden due to cardiovascular disease, COPD, and diabetes mellitus increases with age and also varies by region.

Conclusions:
The results suggest age-and gender-specific prevention as well as regional health care needs. BoD studies therefore provide comprehensive data for population health surveillance and can support health policy decisions. Key messages: The importance of specific diseases as measured by DALY differs greatly by age and gender, highlighting the need for targeted prevention measures. Regional patterns emerge for cardiovascular disease, COPD, and depressive disorders, among others, which may indicate health care needs.
15th European Public Health Conference 2022