Personalised prevention in action across European health systems: lessons from the PROPHET Framework

Background

Personalised prevention (PP) aims to target interventions based on the combination of biological, lifestyle and socioeconomic factors, but requires structured approaches integrating organisational, equity, societal dimensions. The EU-funded project PeRsOnalized Prevention roadmap for the future HEalThcare (PROPHET) had recently proposed an implementation framework for PP interventions, combining Health Technology Assessment (HTA), Health Impact Assessment (HIA), and monitoring aspects. This study investigates its potential uptake across European health systems.

Methods

We conducted semi-structured interviews with high-level stakeholders in four countries (Italy, the Netherlands, Finland, and Estonia), representing different health system models. Participants included representatives from ministries, academia, clinical practice, patient networks. Interviews explored system readiness for the PROPHET Framework applicability focusing on governance, evaluation, and monitoring.

Results

Twenty-four stakeholders were interviewed (Italy n = 7; the Netherlands n = 5; Finland n = 7; Estonia n = 5). PP remains at an early stage, with limited system readiness. Contextual differences emerged: Finland shows strong data but limited implementation; the Netherlands strong HTA but weaker integration of HIA and monitoring; Italy regional heterogeneity; Estonia mixed readiness with workforce gaps. Common barriers emerged: governance as the main challenge, with unclear roles and weak coordination. Limited HIA institutionalisation, fragmented monitoring, data gaps constrain implementation. The PROPHET Framework was seen as valuable, but its uptake is limited by structural constraints.

Conclusions

Similar barriers affect uptake across countries. Strengthening governance, clarifying roles, and integrating HTA, HIA and monitoring into decision-making are key priorities. The PROPHET Framework is promising but needs alignment with national contexts and stronger coordination.

Key messages

• Personalised prevention in Europe remains at an early stage, with limited system readiness and persistent governance challenges across countries.

• The PROPHET Framework offers a valuable approach to advancing personalised prevention, though its uptake is still limited by systemic barriers.