Abstract
Background: Current economic evaluations (EEs) of precision medicine (PM) often adhere to generic
reference cases (RC) which overlook PM’s unique healthcare paradigms. This study aimed to develop a
PM specific RC to standardize the conduct and reporting of EEs of PM.
Methods: A working group of 5 core health economists, 22 PM experts, and research staff from Singapore,
Thailand, and Australia who were actively engaged in EE and clinical implementation of PM was
constituted. The development of RC comprised of four stages: 1) expert consultations shaping the RC’s
scope and structure into nine domains: Population, Intervention, Comparator, Cost, Outcome, Time,
Equity and ethics, Adaptability, Modelling (hereby referred as “PICCOTEAM framework); 2) a comprehensive
literature review on current approaches and challenges in PM EEs; 3) obtaining expert consensus and
drafting recommendations; 4) a workshop for refining the RC based on stakeholder feedback on relevance
and feasibility.
Results: Following an in-person experts workshop, a consensus was reached to tailor PM recommendations
for screening, diagnosis, pharmacogenomics, market access, and early EEs. The PICCOTEAM RC offers 36
recommendations for conventional EEs to guide PM reimbursement. The RC emphasizes expert
engagement, iterative study processes, disease-specific outcomes, decision uncertainty analyses, and
equity analysis. Additionally, 23 recommendations are provided for early-stage evaluation to enhance
PM’s positioning and value proposition, mitigating uncertainty, equity, and ethical issues.
Conclusions: The PICCOTEAM RC offers a standardised process to conduct and report diverse PM EEs. This
will serve as guidance for health departments, researchers, clinicians, editors, and reviewers. Pilot testing
and continuous updates are recommended for the ongoing relevance and applicability of this RC.
