Study: Costa Rica with the conditions to implement personalized medicine


The research report “Personalized medicine in Latin America: Universalizing the promise of innovation”, prepared by the Intelligence Unit of The Economist (EIU, for its acronym in English), reveals that Costa Rica has the conditions to move towards the adoption of a personalized health care approach despite some pending challenges in its objective of impacting the entire population; Furthermore, it highlights that it is the Central American country with the best social, political, economic and health conditions for its application.

To contribute to greater and better local coverage, The study recommends the construction of an initial frame of reference that includes issues of governance, awareness and attitudes, infrastructure and financial management, where patients, the medical community and health authorities understand the possibilities and challenges of personalized medicine in aspects such as patient and doctor education, improvements in digital and laboratory infrastructure, transition to advances in medicine, among others issues.

The study had the support of Roche Latin America and, in addition to Costa Rica, it included Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru and Uruguay.. The nine countries were categorized as level one, two, or three, based on their assessment of the basic elements necessary for the successful implementation of personalized medicine, and where they are in the process.

The report places Costa Rica, Argentina, Brazil, Colombia and Uruguay at level one, countries that it considers “ready to decide”, as it has substantial elements of the reference framework, but with important gaps in terms of its evaluation. At this level, Costa Rica is the Central American country best prepared to decide whether to create a comprehensive approach encompassing its entire health system and not just separate initiatives, which allows accompanying each patient on their journey, from prevention to treatment and monitoring. identifying your needs.

Personalized medicine: national advance

“Personalized medicine is based on molecular information and the use of large-scale data, which allows responding to the individual needs of patients, improving the diagnosis and treatment of their disease, with precise therapeutic decisions to have more effective results. reliable; which strengthens health systems, through the efficient use of resources, which supports their long-term sustainability, ”said Dr. María Clara Horsburgh, medical director of Roche Central America and the Caribbean.

Medical advances, technology, genomics and data science converge in this new approach to medicine, which, in addition to the potential to improve clinical outcomes for patients, allows health ecosystems to make decisions based on data, making more efficient use of the resources.

The EIU study estimates that around 50 million people around the world use health applications on their cell phones (mHealth) to conduct self-assessments. In the case of Costa Rica, all patients in its health system have a Unique Digital Health Record (EDUS) that has its own mobile application. On the other hand, the analysis highlights that the country has extensive experience in telemedicine, dating back to 1994.

In the country, there are 61% of users who have a digital medical record, within a legal framework that protects the privacy of their data. In 2017, the Organization for Economic Co-operation and Development (OECD) found that only 10 of the 28 member countries it examined had electronic health record agreements that could be described as excellent health information that support quality, efficiency and reliability. performance of health systems.

According to EIU research, to adopt personalized medicine, countries should have value-based models of care, digitization of healthcare (including electronic medical records), incorporation of real-world evidence into regulatory processes, and Health Technology Assessment ( ETS). In this sense, at the local level there is no single consolidated HTA body, but rather a Committee made up of multiple agencies. Although, the research emphasizes, although the number of laboratories is probably sufficient for a country of this size, the quality is variable.

Policies related to personalized medicine exist and are common. In Costa Rica, the health system is developing initiatives such as the National Genomic Data System, the Neonatal Screening Program, and the National Uterine Cancer Program; Furthermore, it is hosting some personalized initiatives, but not for all the conditions for which they are available. This transition involves much more than simply adopting new treatments as they are discovered.

As explained by Dr. Horsburgh, in complex therapeutic areas such as Oncology and Rare Diseases, personalized medicine allows an early and accurate diagnosis, as well as better risk management and specific care plans. “At the country level, cancer registries are expanding their coverage, documenting their types and the number of cases; also, it has records of its entire population, but they are specific for birth diseases and not for all rare diseases ”, he commented on the report.

Despite these advances, in regional cancer control plans, there is no substantive debate on the application of personalized cancer treatments or research. In fact, the report indicates that, in 2017, only 11 of the genetic mutations in any cancer had associated and approved treatments. For the good of society, advances are happening quickly: 42% of the drugs approved in 2018 by the US Food and Drug Administration (FDA for its acronym in English) could be classified as precision medicine.

Interventions to accelerate the adoption and access to precision medicine must be articulated between pharmaceutical companies, the State, professionals, patients, among others, and must work under the principles of Science, Ethics, and the rationality of the use of resources, but where the result and patient satisfaction prevail, since personalized attention does not focus on treating diseases, but people.

As the report concludes, public understanding, political will, better scientific infrastructure, and effective health technology assessment can drive not only the adoption of personalized medicine, but also the evolution of health systems toward comprehensive solutions for the benefit of the patient.

“We are at a fundamental moment to articulate the different sectors of the healthcare ecosystem to build together the framework that supports the adoption of personalized medicine. This includes changes in the governance of the health system, knowledge of technology by stakeholders, the development of infrastructure that can produce a variety of personalized interventions, and institutional management that provides access to the best elements of personalized medicine, so that each patient receives the correct diagnosis and treatment in a timely manner, ”concluded Dr. Horsburgh.


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