A whole-system approach to delivering personalised medicine and health in Leeds. Mike Messenger

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1 A whole-system approach to delivering personalised medicine and health in Leeds Mike Messenger

2 Capacity and Resource What is the challenge? In 2016, we face the most significant challenges for a generation. We know that we must keep innovating and improving if we are to meet the needs of our population in a tough financial climate WY STP Biomedical Research 1st Gap in Translation Technology Development & Market Approval 2nd Gap in Translation Clinical Practice & Adoption Academia Industry Health & Care Translational Continuum (adapted from years years

3 A Whole-System City-Wide Approach

4 Personalised Medicine & Health uses technology, information and evidence to enrich and improve the health and care decisions made by patients and the public, supported by clinicians Data storage Data linkage Better Actions, Outcomes & Affordability Healthcare data acquisition Metadata (Quality & Accuracy) Improving Patient-Clinician decision making (> accuracy, tailoring, timing, participation) Effective Communication Analysis and interpretation

5 Personalised Medicine and Health Prediction & Prevention Early Diagnosis Prognosis Disease Screening Molecular Phenotyping Treatment benefit / response Monitoring Recovery Hospital admission Death Disease Free Asymptomatic Disease Symptomatic Disease Acute disease diagnosed Disease response Hospital discharge Late side-effects Chronic disease relapse Treatment initiation Shift towards maintaining health and preventing disease

6 Centre for Personalised Medicine and Health Our Purpose: Enable Leeds s population to benefit from the latest innovations in personalised medicine and health, by accelerating their discovery, development, evaluation and adoption. Academia Our Vision: Make Leeds and the UK a global leader in Personalised Medicine and Health Service Provision, Research, Education and Business Industry Health & Care

7 Rapid Generation of Evidence for Adoption The Push New Diagnostic Technologies Industry Academia NHS pathology Precision Medicine Research Infrastructure Patient Cohorts, Biobanks, Big Data, Analytical Platforms (e.g. Omics), High Performance Computing Patient Benefit Early Modelling (Commercial and NHS opportunity) Measurement Validity Clinical Validity Clinical Efficacy & Utility Cost- Effectiveness Dissemination & Adoption The Pull Clinical Need NHS Academia Industry Stakeholders Methodological expertise Health Economics, Health Informatics, Medical Statistics, Metrology, Systems Biology, Quality Management, Artificial Intelligence Economic Value

8 Personalised Medicine Infrastructure Research Council Charity NIHR University of Leeds NHS Commercial Discovery Evaluation Adoption MRC Medical Bioinformatics Informatics Centre MRC Single Cell Genomics Centre MRC Hyper-polarised MRI Centre Wellcome Trust Institute of Biomedical Engineering EPSRC Innovation Knowledge Centre Cancer Research UK Centre Leeds YCR Centre for Early Phase Clinical Trials Myeloma UK Test Bed Experimental Cancer Medicine Centre NIHR Leeds Musculoskeletal Biomedical Research Unit NIHR Clinical Research Facility NIHR Colorectal Therapies Health Technology Cooperative NIHR Diagnostic Evidence Cooperative Astbury Centre for Structural Biology Multidisciplinary Cardiovascular Research Centre Institute of Medical and Biological Engineering Leeds Multi-disciplinary Research Tissue Bank Leeds Clinical Trials Research Unit Leeds Integrated Care Record Health & Social Care Information Centre National Haemato-Oncology Centre? Yorkshire and Humber AHSN CLAHRC Yorkshire and Humber PM s Challenge CCGs Integration Pioneers Vanguard ResearchOne Precision Medicine Catapult Centre of Excellence in Leeds

9 Built on Strong Health Informatics 2.5 million patients 4 million diagnosis events 5,000 clinical users Plain text EPR e.g. letters Coded database e.g. diagnosis 100% of 105 GP surgeries Regularly used by 3845 healthcare professionals

10 Methodological Expertise Health Economics Health Informatics Study and Trial Design Method Validation Also: AI/Machine Learning Behavior Change Systems Biology Decision Analysis Adoption/Implementation Design/Human Factors IP & Business models Ethical/Legal/regulatory Patient/Public participation Quality & Process Methods

11 Diagnostic Evidence Co-operative Case Study 1 Tumour profiling for solid tumour cancer patients in the NHS Dr Geoff Hall

12 Advanced molecular profiling IHC, FISH, NGS, PCR, Pyro sequencing 592 Cancer-Related Genes Detecting 4 Classes of Genomic Alterations NHS Regional Innovation Fund Feasibility study Recurrent ovarian cancer Assess impact on clinician decision Frequency of druggable target Supported by data available from PPM+ electronic patient record

13 Caris Case Report 58 year old, stage 3c, high-grade serous ovarian cancer Germline testing, NHS Caris Profile, Trial

14 Diagnostic Evidence Co-operative Case Study 2 Acute kidney injury (AKI) Diagnostics Andrew Lewington & Peter Hall

15 1. Describe the Care Pathway 2. Systematically review 3. Identify decision points 4. Evaluate clinical and cost effectiveness 5. Characterise uncertainties 6. Prioritise tests 7. Identify efficient study designs

16 :Early Modelling Approach extra QALYs at a cost of 301 ICER of $24956 per QALY 48% probability of being cost effective

17 :Value of Information Analysis

18 Future Projects

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