Purpose: Given the high burden of Chronic Obstructive Pulmonary Disease (COPD), development of biomarkers that can improve its prevention and management might have enormous impacts on public health. The benefits of a potential biomarker can be realized through: 1) detecting high risk individuals and permitting the early diagnosis; 2) reducing the misdiagnosis of COPD as other respiratory conditions and avoiding inappropriate interventions; and 3) accelerating the discovery of novel therapeutics whose effectiveness exceeds the current palliative medications. We estimated the net monetary benefit of biomarker discovery for COPD.
Method: We constructed a mathematical model to calculate the direct and indirect costs of COPD for a 25 year period in Canada. We also modeled mortality and morbidity due to COPD in terms of quality adjusted life years (QALYs) and converted it into monetary values using a willingness to pay threshold of $50,000 per QALY. We estimated the monetary benefit of a hypothetical biomarker on reducing the total costs associated with COPD under various assumptions about its performance. Net monetary benefit (NMB) of a biomarker guided strategy was defined as the monetary benefit of the biomarker strategy minus the cost of using that biomarker in practice.
Result: Direct and indirect costs of COPD were estimated to be more than $66 billion over the next 25 years in Canada. The monetary impact of COPD through QALY loss was estimated as $98 billion in the same period. Results suggest that even if a biomarker can save 1% of these total costs, it will create a substantial net monetary benefit under the assumption that it can be marketed with a relatively low price (e.g. less than 50$ per test). Biomarkers that are predictors of disease phenotypes or treatment response are unlikely to have the capacity to cause a substantial reduction in the monetary harms of COPD. However, biomarkers that facilitate smoking cessation/prevention through earlier diagnosis and biomarkers that facilitate the drug discovery process by functioning as surrogate markers in clinical trials have more promise.
Conclusion: We believe that 1% to 5% decrease in total cost of COPD is an achievable target for a successful biomarker. Biomarkers that facilitate early diagnosis or individuals at risk, and those that can act as surrogate markers in clinical trials should be given priority.
Candidate for the Lee B. Lusted Student Prize Competition