IMAGINARY WORLDS: REPRODUCIBILITY AND MODELED CLAIMS IN PRECISION MEDICINE
Developing decision models to support comparative cost-effectiveness claims is now an accepted standard in submissions both to gatekeepers for single payer health systems as well as to health system formulary committees. Unfortunately, looking back over the past 25-30 years few, if any, of the modeled claims presented meet the standards of normal science: they fail to support testable and reproducible claims for the impact of drugs and devices in health systems. They are, in effect, imaginary worlds or thought experiments. If we are to advance our understanding of the impact of interventions in health care through the discovery of new facts in precision medicine, then we must adhere to the standards of normal science. Guidelines need to be put in place that recognize
the central role of testable modeled claims and the role of reproducibility and feedback from claims assessment to health care decision makers.