An Index of Barriers for the Implementation of Personalised Medicine and Pharmacogenomics in Europe

Background: Personalised medicine (PM) is an innovative way to produce better patient outcomes by using an individualised or stratified approach to disease and treatment rather than a collective treatment approach for patients. Despite its tangible advantages, the complex process to translate PM into the member states and European healthcare systems has delayed its uptake. The aim of this study is to identify relevant barriers represented by an index to summarise challenging areas for the implementation of PM in Europe. Methods: A systematic literature review was conducted, and a gaps-and-needs assessment together with a strengths-weaknesses-opportunities-and-threats analysis were applied to review strategic reports and conduct interviews with key stakeholders. Furthermore, surveys were sent out to representatives of stakeholder groups. The index was constructed based on the priorisation of relevant factors by stakeholders. Results: A need for stakeholder-agreed standards at all levels of implementation of PM exists, from validating biomarkers to definitions of ‘informed consent'. The barriers to implement PM are identified in 7 areas, namely, stakeholder involvement, standardisation, interoperable infrastructure, European-level policy making, funding, data and research, and healthcare systems. Conclusions: Challenges in the above-mentioned areas can and must be successfully tackled if we are to create a healthier Europe through PM. In order to create an environment in which PM can thrive for the patients' best outcomes, there is an urgent need for systematic actions to remove as many barriers as possible.

[1]  J. Ronquillo How the Electronic Health Record Will Change the Future of Health Care , 2012, The Yale journal of biology and medicine.

[2]  Casey Lynnette Overby,et al.  Personalized medicine: challenges and opportunities for translational bioinformatics. , 2013, Personalized medicine.

[3]  M. West,et al.  Embracing the complexity of genomic data for personalized medicine. , 2006, Genome research.

[4]  Genelex Corporation. , 2008, Pharmacogenomics.

[5]  Harry Enchin,et al.  Clinician Adoption of Genetic Testing for Drug Metabolizing Enzymes: Is Patient Safety The Low-Hanging Fruit of Personalized Medicine? , 2009, AMIA.

[6]  N J Cox,et al.  The 1200 Patients Project: Creating a New Medical Model System for Clinical Implementation of Pharmacogenomics , 2012, Clinical pharmacology and therapeutics.

[7]  G. Ginsburg,et al.  Overcoming barriers in the implementation of personalized medicine into clinical practice. , 2013, The Israel Medical Association journal : IMAJ.

[8]  W. Chung Implementation of genetics to personalize medicine. , 2007, Gender medicine.

[9]  P. Deverka Pharmacogenomics, Evidence, and the Role of Payers , 2009, Public Health Genomics.

[10]  F. Ashbury,et al.  Personalised medicine in Canada: a survey of adoption and practice in oncology, cardiology and family medicine , 2011, BMJ Open.

[11]  Kenneth Cornetta,et al.  Balancing personalized medicine and personalized care. , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[12]  D. Roden Cardiovascular pharmacogenomics: the future of cardiovascular therapeutics? , 2013, The Canadian journal of cardiology.

[13]  John S. Luque,et al.  Formative Research on Perceptions of Biobanking: What Community Members Think , 2011, Journal of Cancer Education.

[14]  B. Shastry,et al.  Pharmacogenetics and the concept of individualized medicine , 2006, The Pharmacogenomics Journal.

[15]  R. Mckinnon,et al.  Personalized medicine: potential, barriers and contemporary issues. , 2012, Current drug metabolism.

[16]  S. Scott,et al.  Personalizing medicine with clinical pharmacogenetics , 2011, Genetics in Medicine.

[17]  Edd Fleming,et al.  The microeconomics of personalized medicine: today's challenge and tomorrow's promise , 2009, Nature Reviews Drug Discovery.

[18]  E. Galanis,et al.  Incorporation of Prognostic and Predictive Factors Into Glioma Clinical Trials , 2013, Current Oncology Reports.

[19]  R. Mckinnon,et al.  Consumers' views of pharmacogenetics--A qualitative study. , 2010, Research in social & administrative pharmacy : RSAP.

[20]  I. Lee,et al.  Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[21]  G. Rasi,et al.  Cancer Drug Development and the Evolving Regulatory Framework for Companion Diagnostics in the European Union , 2014, Clinical Cancer Research.

[22]  Michael B Ward,et al.  A critical analysis of barriers to the clinical implementation of pharmacogenomics , 2007, Therapeutics and clinical risk management.

[23]  E. Abrahams,et al.  The Case for Personalized Medicine , 2009, Journal of diabetes science and technology.

[24]  W. Gradishar,et al.  Barriers to the use of personalized medicine in breast cancer. , 2012, Journal of oncology practice.

[25]  L. Hood,et al.  Predictive, personalized, preventive, participatory (P4) cancer medicine , 2011, Nature Reviews Clinical Oncology.

[26]  A. Brand,et al.  European Best Practice Guidelines for Quality Assurance, Provision and Use of Genome-based Information and Technologies: the 2012 Declaration of Rome , 2012, Drug metabolism and drug interactions.

[27]  Howard L McLeod,et al.  Economic opportunities and challenges for pharmacogenomics. , 2010, Annual review of pharmacology and toxicology.

[28]  Katherine Chadwell Clinical Practice on the Horizon: Personalized Medicine , 2013, Clinical nurse specialist CNS.

[29]  E. Clayton,et al.  Operational Implementation of Prospective Genotyping for Personalized Medicine: The Design of the Vanderbilt PREDICT Project , 2012, Clinical pharmacology and therapeutics.

[30]  Richard G. Hamermesh,et al.  Realizing the promise of personalized medicine. , 2007, Harvard business review.

[31]  D. Roter,et al.  Patient reactions to personalized medicine vignettes: An experimental design , 2011, Genetics in Medicine.

[32]  N. Babić,et al.  Clinical pharmacogenomics and concept of personalized medicine / Klinička farmakogenomika i koncept personalizovane medicine , 2012 .

[33]  Laszlo Nagy,et al.  The triad of success in personalised medicine: pharmacogenomics, biotechnology and regulatory issues from a Central European perspective. , 2012, New biotechnology.

[34]  Joshua P Cohen Overcoming regulatory and economic challenges facing pharmacogenomics. , 2012, New biotechnology.

[35]  J. Ashton-Chess,et al.  Market access challenges in the EU for high medical value diagnostic tests. , 2011, Personalized medicine.

[36]  Leonard W. D'Avolio,et al.  Detours on the road to personalized medicine: barriers to biomarker validation and implementation. , 2011, JAMA.

[37]  J. Ferrero,et al.  Chimiothérapie ciblée du cancer du sein basée sur une analyse génomique de la tumeur : Adhésion des patientes, craintes et malentendus , 2012 .

[38]  George P Patrinos,et al.  Realities and expectations of pharmacogenomics and personalized medicine: impact of translating genetic knowledge into clinical practice. , 2010, Pharmacogenomics.

[39]  John P. A. Ioannidis,et al.  American Journal of Epidemiology Commentary the Emergence of Translational Epidemiology: from Scientific Discovery to Population Health Impact , 2022 .

[40]  K. Reynolds,et al.  Achieving the Promise of Personalized Medicine , 2012, Clinical pharmacology and therapeutics.

[41]  Marc S. Williams,et al.  The Public Health Genomics Translation Gap: What We Don’t Have and Why It Matters , 2012, Public Health Genomics.

[42]  S. Ely,et al.  Personalized medicine: individualized care of cancer patients. , 2009, Translational research : the journal of laboratory and clinical medicine.

[43]  I. Zineh,et al.  Pharmacogenetics in medicine: barriers, critical factors and a framework for dialogue. , 2009, Personalized medicine.

[44]  Katherine Payne,et al.  Reflections on market access for personalized medicine: recommendations for Europe. , 2013, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[45]  O. Slanař,et al.  Pharmacogenetics in clinical practice. , 2012, Prague medical report.

[46]  Christien Enzing,et al.  EU policies in personalized medicine-related technologies. , 2009, Personalized medicine.

[47]  Larisa H. Cavallari,et al.  Pharmacogenetics and Cardiovascular Disease—Implications for Personalized Medicine , 2013, Pharmacological Reviews.

[48]  Julie O. Culver,et al.  Genetics, genomics, and cancer risk assessment , 2011, CA: a cancer journal for clinicians.

[49]  Geoffrey S Ginsburg,et al.  Personalized medicine: progress and promise. , 2011, Annual review of genomics and human genetics.

[50]  J. Schultze,et al.  Re-overcoming barriers in translating biomarkers to clinical practice. , 2010, Expert opinion on medical diagnostics.

[51]  M. Stocum,et al.  Best practices for companion diagnostic and therapeutic development: translating between the stakeholders. , 2012, New biotechnology.

[52]  P. Meyer,et al.  Legal and ethical concerns in personalized medicine: a European perspective. , 2009, Personalized medicine.

[53]  Julio Benítez,et al.  Pharmacogenetic testing and therapeutic drug monitoring are complementary tools for optimal individualization of drug therapy , 2010, European Journal of Clinical Pharmacology.

[54]  A. Nunn Molecular imaging and personalized medicine: an uncertain future. , 2007, Cancer biotherapy & radiopharmaceuticals.

[55]  Stephen T Holgate,et al.  The future of technologies for personalised medicine. , 2012, New biotechnology.

[56]  J. Trent,et al.  Using biointelligence to search the cancer genome: an epistemological perspective on knowledge recovery strategies to enable precision medical genomics , 2008, Oncogene.

[57]  V. Shah,et al.  AAPS–FIP Summary Workshop Report: Pharmacogenetics in Individualized Medicine: Methods, Regulatory, and Clinical Applications , 2009, The AAPS Journal.

[58]  D. Lacombe,et al.  Towards personalized medicine in the EU: what is needed to facilitate the complex international clinical research? , 2013, Personalized medicine.

[59]  M. Relling,et al.  Development and implementation of a pharmacist-managed clinical pharmacogenetics service. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[60]  T. Burt,et al.  Pharmacogenomics in early-phase clinical development. , 2013, Pharmacogenomics.

[61]  Edith A Perez,et al.  Breast cancer management: opportunities and barriers to an individualized approach. , 2011, The oncologist.

[62]  C. Pui,et al.  Pharmacogenomics and Individualized Medicine: Translating Science Into Practice , 2012, Clinical pharmacology and therapeutics.

[63]  J. Patel,et al.  Application of genotype-guided cancer therapy in solid tumors. , 2014, Pharmacogenomics.

[64]  M. Pirmohamed Acceptance of Biomarker‐Based Tests for Application in Clinical Practice: Criteria and Obstacles , 2010, Clinical pharmacology and therapeutics.