In Reply Ms Chen and Dr Hay make the point that cost-effectiveness studies often model the local health care environment. They suggest that in modeling cost-effectiveness, many factors are important and point out that each decision is somewhat arbitrary, meaning that the final model is interpretable only in the context of those decisions. I completely agree.
Given their emphasis on careful selection of factors critical to the model outcome, it is surprising that Chen and Hay speculate that genetic testing may be more expensive in the United States compared with Europe. In fact, the cost of sequencing a human genome has decreased almost 1 million fold, and the National Human Genome Research Institute1 regularly updates a graph showing how much faster the cost of human sequencing has decreased than the law defined by Gordon Moore. (The law by Moore, co-founder of Intel, describes how the number of transistors on an integrated circuit doubles every 18 months.)
Ashley EA. Promise of Precision Medicine—Reply. JAMA. 2015;314(16):1752. doi:10.1001/jama.2015.11197