Hannah Mamuszka, a cofounder of consultancy Alva10, has released a Go-To Essay on the Value of CDx, particularly in a world where drugs are increasingly expensive.
This caught my attention in part because I was able to co-author an article this spring about how diagnostics get more and more cost-effective as drug costs rise (Kansal et al., 2026).
Mamuszka discusses a wide range of emerging drug/test examples, and discusses some marketplace disincentives to better HEOR.
Find Mamuszka's essay at Substack here:
https://substack.com/home/post/p-196116530
Here’s a ~200-word summary / Chat GPT:
Hannah Mamuszka argues that the national debate over drug prices misses half the problem: many drugs are prescribed to patients who will never respond to them. Modern drug development often targets specific biological pathways, yet prescribing still frequently proceeds by trial and error. TNF inhibitors, for example, may work well for patients whose disease is TNF-driven, but response rates are often only around 30–40%. Similar issues occur across oncology, autoimmune disease, cardiology, psychiatry, and other fields.
The remedy, she argues, is broader use of diagnostics that predict either drug response or serious toxicity. Pharmacogenomic tests can identify patients at risk from drugs such as fluoropyrimidines, thiopurines, abacavir, clopidogrel, and antidepressants. Response-prediction tests can determine whether a patient’s disease biology matches a drug’s mechanism, as already accepted in many areas of oncology.
The obstacle is not scientific feasibility, but market design. Pharma benefits from broad drug markets; PBMs may favor drugs with higher rebates; insurers often resist paying for tests. But employers and patients may increasingly see the value of diagnostics that prevent months of ineffective, costly, or harmful treatment. The core message: precision diagnostics are not a luxury; they are a way to stop paying for predictable failure.
