We are very excited about individualized medicine as a way of providing better care and reducing costs. This post, we're talking about the field of Pharmacogenomics. What the heck is that? After you read on, you'll be a fan too.
Today, genetic testing is commonly used to determine ancestry, predict the risk of some cancers, and to determine which chemo treatments may provide a better outcome for a specific patient. Now, genetics can also be used to predict a patient’s response to more than 60% of commonly prescribed drugs– through a field called pharmacogenomics. I first learned about pharmacogenomics at the 2018 ISCEBS Symposium in Boston. Veronika Litinski, the CEO of Toronto—based GeneYouIn, spoke about this emerging field of genetics.
Pharmacogenomics (also referred to as pharmacogenetics, or PGx) uses a patient’s genetic information to individualize medication as well as dosages. A cheek swab is used to test different genes, providing information about how fast (or slow) a patient metabolizes drugs. For a large percentage of the population, a specific drug will be metabolized normally. But for those who metabolize the drug rapidly or slowly, it can cause serious consequences. Those who are fast metabolizers don’t receive the benefit of the drug since their body breaks down the drug too quickly. Slow metabolizers can end up with drug toxicity. In the US, adverse drug reactions are the 4th leading cause of death.
PGx testing covers prescriptions in such treatment areas as mental health, pain management, digestive system, heart disease, oncology, rheumatology, and more. The list of medications added to the testing is growing rapidly, and because a person’s genetics don’t change, the test results can be updated over time without requiring retesting.
Return on Investment
A typical PGx test costs between $250 and $500 per person. A reputable company will continue to provide additional drug metabolism updates as new drugs come on the market. This cost is small, especially when considering these statistics:
Reducing Disability Claims
One US study, in 2013, found that people taking antidepressants matched to their genetic profile had 69% fewer healthcare related visits and one-fourth the disability claims compared to people who took an antidepressant that was a genetic mismatch.
Recognizing the potential to lower disability claim costs, Canada’s three largest disability insurers have launched PGx studies:
Countries Courting PGx
If the positive impacts are resoundingly clear, why aren’t more PGx tests conducted in the U.S. where skyrocketing drug costs are driving up healthcare expenses? While the United States allows licensed healthcare providers to order a PGx test, most insurance companies will not cover the cost. As in other areas of healthcare, other countries have adopted a much broader stance:
The Bottom Line
I’ve said it before, and I will say it again. The future of medicine – both for better patient outcomes and cost reduction - is “individualized care”. The PGx test is another great example of this. It seems a “no brainer” to include as part of hospital pre-admission testing, for those in home healthcare, and patients taking five or more drugs. A case can also be made to automatically test those who are taking, or are in need of taking, pain medications, antidepressants, or other drugs where “trial and error” is required to land on the right drug and dosage. While US health insurance carriers may not see the return on investment yet, I wager that employers with self-funded medical plans will be early adopters, as well as US-based long term disability carriers.
PGx Testing Companies:
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I love numbers. I'm a math geek. I read benefits industry articles and periodicals for relaxation (but, honestly, I'm still a fun gal). I also like to share what I've learned and you'll find it all here.