Cost-Effectiveness of Genetic Testing to Minimize Adverse Drug Reactions
A recent case study of the Teachers Retirement System of Kentucky (TRSKY) found that pharmacogenomics not only reduced health care costs but increased the effectiveness and safety of drug treatments.
Pharmacogenomics (sometimes called pharmacogenetics) is a field of research that studies how a person’s genes affect how he or she responds to medications.
“Pharmacogenomics is the field that analyzes the link between drug metabolizing enzyme (DME) genotypes and drug metabolism,” said the Behind the Bench staff in the October 2021 Accelerating Science article. “There is an increasing interest among patients, medical practitioners, governmental health services and insurance providers to use pharmacogenomics to increase the effectiveness and safety of drug treatments. Finding the most effective, safe, and economical treatment options involves making sure the recipient’s genotype can metabolize the drug as intended.”
The Costs of Adverse Drug Events
The National Action Plan for Adverse Drug Event (ADE) Prevention says that a large majority of ADEs are preventable.
An adverse drug event has been defined by the Institute of Medicine as “an injury resulting from medical intervention related to a drug.”
ADEs include medication errors, adverse drug reactions, allergic reactions, and overdoses.
These unwanted side effects, which can sometimes be life-threatening, come at a great cost to the health care system including:
- An estimated 1 million emergency department visits yearly
- 125,000 patients admitted to hospitals annually
- 1 in 3 hospital adverse events are caused by ADEs
- Some 2 million hospital stays each year are affected by ADEs
- ADEs by hospitalized patients prolong their stay by an average of 1.7 to 4.6 days
- Over 3.5 million physical office visits each year are due to ADEs
The National Action Plan for Adverse Drug Event Prevention says that the economic costs have not been studied as closely as the physical costs but that a 2006 study estimated that ADEs added an additional $3.5 billion to U.S. health care costs.
“In the current climate of finding ways to decrease healthcare costs, it is therefore important to rapidly determine the treatment and dosage that treats the pathology most effectively,” said the Accelerating Science article.
Using Genetic Testing and Personalized Therapy Analysis to Improve Medication Safety
The TRSKY pilot program collected detailed medical information on 5,900 members who were part of a pension fund that includes 34,00 retirees, ages 65 to 107.
The group included the following medical conditions:
- 75 percent had high blood pressure or heart disease
- 58 percent had high cholesterol
- 50 percent had pain or inflammation
- They took an average of 15 prescriptions to treat the above conditions and other ailments
“That’s a lot of copays and a lot of potential for side effects, adverse drug reactions, drug-drug interactions, and drug-gene interactions,” said Coriell, who helped conduct the study.
Initial analysis identified patients taking the wrong dose, those that should stop taking a certain medication, and notifying patients of better alternatives for their medication resulted in a potential savings of $16 million.
Genetic testing was the next step with genomic samples collected from patients, with the results finding that almost 84 percent of the members were on at least one drug known to be affected by genetics.
Medication action plans were then formulated after the genomic sequences were analyzed. Patients conferred with geneticists, doctors, and pharmacists to understand their genetic reports, which included:
- Pharmacogenomic alerts
- Known drug-drug interactions
- Lifestyle factors
- Age-related toxicity risks
- FDA black box warnings
- Medication risks associated with cognitive impairment
Case Study: Reduced Spending, Lower Hospitalizations
The success of the TRSKY program was evident in reduced spending on medications along with lower hospitalizations and admissions.
The Accelerating Science article says that the genetic testing led to:
- 57 percent of patients were able to optimize their drug doses
- 33 percent found better alternative medicine to take
- 10 percent were able to stop taking one of their medications complexly
MA3, which measures medication adherence, medication appropriateness, and medication adversity, was tracked and a 28 percent reduction in MA3-related risk incidents was indicated.
When it comes to costs, there was an eye-catching stat as the TRSKY patients in the genetic testing program lowered their cost-to-plan spending by 17 percent in six months vs. the non-participants that had a 2.5 percent increase in spending over the same period.
The bottom line: the insurance underwriter calculated that if the genetic testing program was extended to the full TRSKY membership, annual health care costs for the fund would be reduced by $21.7 million.
Benefits of Preemptive Pharmacogenomics
If preemptive pharmacogenomics for a membership of 34,000 patients can save an estimated $21.7 million, imagine the benefits to the wider health care system if genetic testing was embraced.
“In short, by knowing the patient’s DME genotypes, the appropriate drug, correct dose, and biologically active version can be matched to the individual,” concluded the Accelerating Science article. “In many cases, this information will increase efficacy, increase safety, decrease discomfort, and reduce costs. Pharmacogenomics therefore has enormous potential to improve the healthcare system for all participants.”
The reaction of patients to the genetic testing and resulting changes they were able to make to their medication? “This is what health care should be,” said one patient.
The Journal of Personalized Medicine published an article in March 2022 and agreed with the conclusion: “We document the impact of a large real-world implementation of a pharmacogenomics enriched comprehensive medication management (PGx + CMM) program in the US. By deploying these tools, supported by a robust and efficient clinical decision support system, patients, healthcare providers, and the system as a whole benefited in synergistic ways. The observed reduced costs, meaningful shifts in the patterns of patient healthcare resource utilization, as well as other encouraging trends suggest that wide-spread adoption could significantly advance the goals of the Quadruple Aim in health systems globally.”
Contact Wise Dx today to learn more about our mission to serve nursing homes, long term care facilities and health specialists with molecular testing platforms that help achieve better patient outcomes.
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