Pharmacogenomics – testing a patient’s genetic makeup to guide safer, more effective medication choices and dosing – is not a new concept. But, like so many other clinical innovations, adoption has been sluggish.
Some specialties, like oncology, have been quicker to embrace the promise of pharmacogenomics (PGx), and their successes can serve as a roadmap as others explore the impact it can have on quality, outcomes and patient satisfaction.
Considering successes in oncology
It stands to reason that oncologists would serve as early adopters. They’ve recognized for decades that medication “behaves” in different ways under different circumstances with different patients – as evidenced by the frequency of off-label use and reliance on enrollment in drug clinical trials. The value of PGx testing was further reinforced not long ago when the Food and Drug Administration (FDA) added a black-box warning to the common chemotherapy medication capecitabine. It requires oncologists to assess patient genetic risk for severe toxicities, which could include severe adverse reactions or death from the drug, prior to treatment.
Additionally, oncologists have found PGx critical when prescribing medications to treat patients for conditions that often accompany cancer: antiemetics, for instance, and antidepressants. These common use cases reach well beyond oncology and demonstrate value for providers across all specialties.
Recognizing how PGx lowers cost, improves outcomes
The core value of PGx is readily understood: Some patients are genetically disposed to metabolize certain medications very quickly – which means their bodies never get the full value of treatment before the body “clears” the medication and efficacy is therefore low. Others metabolize some drugs slowly, leading to build-ups in the system, side effects and possible toxicity.
Adverse reactions to drugs are costly. It’s estimated 1.3 million emergency department visits can be attributed to patients experiencing side effects or bad reactions from a prescribed medication. Drug-gene interactions can likewise prolong hospital stays, drive up cost of care, and possibly cause serious injury or death.
These adverse interactions also can lead to patient noncompliance, which comes at its own cost. Cardiologists and endocrinologists, for instance, might find that patients are struggling with side effects triggered by statins that are influenced by PGx – and therefore those patients quit taking their medications. PGx testing allows these specialists not only to choose the medications most likely to be well tolerated but also convince skeptical patients in advance that they are unlikely to experience side effects, thanks to close attention to their unique genetic makeup.
PGx also plays a key role in ensuring the right medication is prescribed the first time, increasing the odds that patients will achieve the desired outcomes sooner, which lowers costs while increasing satisfaction. For instance, any specialist prescribing SSRIs without the benefit of PGx testing is often forced to use a trial-and-error approach. This lengthens the time to remission as one drug is tried, often chosen based solely on the provider’s preference or experience. If it fails, dosage is adjusted, sometimes multiple times. If this, too, fails, the process resets with a new medication…and on and on.
Specialists can also employ PGx testing to short-circuit prescribing cascades. Consider, for example, when a provider prescribes pain medication to a patient. However, the patient may not metabolize that drug well and so the provider increases the dosage to achieve relief. That, in turn, triggers nausea and an antiemetic is consequently added to the mix. This cycle could conceivably spiral out of control. However, if the provider had greater understanding of the patient’s response to different pain medications, he or she could ensure that the most effective therapy with least potential side effects is prescribed.
Leveraging PGx is easier than most think
Specialists who have not used PGx testing in the past might be hesitant because they are not sure how to order the appropriate tests, are concerned about cost, and are uncertain about how to interpret and apply results that are returned to them.
Over the past several years, fortunately, processes and solutions have been developed to overcome these perceived barriers.
In fact, PGx testing is no more difficult than ordering other simple lab tests. Many healthcare organizations contract with labs offering or specializing in PGx testing and may have implemented software to centralize and simplify those ordering processes. Typically, these tests cost no more than other commonly ordered lab panels, and many are covered by Medicare, Medicaid or commercial insurance when medically justified. PGx testing, in fact, may even ease prior authorization processes because they provide insights that can be referenced when patients have experienced multiple drug failures.
Many tools are available to help specialists leverage the information provided in PGx test results. Labs themselves can deliver easy-to-understand feedback based on FDA guidance, CPIC (Clinical Pharmacogenetics Implementation Consortium) guidelines and other established sources. Point-of-care software tools likewise ensure the reports are readily available, simple to understand and can be used during clinical decision making.
Understanding the value of ‘test once, query often’
One of the greatest benefits of PGx testing, however, is that it can be performed once and queried far into the future. Unlike other lab work – e.g., metabolic profiles or lipid panels – PGx tests never need to be repeated, and results can be applied to future prescribed drugs or medications new to the market. This means any specialist can order a full PGx panel on a patient and reference it during any future episode of care when prescribing decisions need to be made – whether for the same or a different condition. Likewise, the results can be queried by other specialties within the healthcare organization, because results can be fully integrated into the patient’s medical record when appropriate software tools are utilized.
The result: Safer prescribing practices and better patient outcomes across the board.
The pressure on every provider to maintain focus on quality, outcomes and satisfaction will only intensify – as will the crippling burden of continuing to reduce costs. PGx is among the rare advances that help specialists across the healthcare enterprise to meet these demands without interfering with familiar clinical workflows or adding unnecessary complications to their clinical decision making.
Photo: Alena Butusava, Getty Images
Carla Balch leads the healthcare software and services division of Aranscia, which also owns AccessDx Laboratory. Previously, she was founder and CEO of Spesana.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.
