Adoption of pharmacogenomic (PGx) testing into clinical practice has been slow. One barrier for implementation is the cost associated with testing, which discourages patients, clinicians, and payers. Demonstrating the potential economic impact from PGx testing may be a way to increase adoption into clinical practice.
While there may be some situations where payers reimburse for the cost of PGx testing, there still remains uncertainty regarding the return on investment. Although several published studies have indicated the positive impact of PGx testing on economic outcomes, there is still a need to continue demonstrating this value. Specifically, studies demonstrating the value of PGx testing in populations with a high prevalence of polypharmacy, such as in Programs of All-inclusive Care for the Elderly (PACE), are scarce.
The publication, Cost avoidance related to a pharmacist-led pharmacogenomics service for the Program of All-inclusive Care for the Elderly, was a cross-sectional evaluation of data from the Implementation of a pharmacist-led pharmacogenomics service for the Program of All-Inclusive Care for the Elderly (PHARM-GENOME-PACE). In the recent Cost Avoidance study, pharmacist-conducted PGx consultations were reviewed to evaluate genetic variants, drug-gene interactions, drug-drug-gene interactions, and phenoconversions. Researchers defined ‘actionable’ drug-gene pairs as having clinical evidence and recommendations in the US Food and Drug Administration (FDA)-approved drug labels, the Clinical Pharmacogenetics Implementation Consortium (CPIC®) guidelines, or the Dutch Pharmacogenetic Working Group (DPWG) guidelines. Within the ‘actionable’ category, drug-gene pairs were further divided into three categories (i.e., clinically actionable, potentially actionable, or possibly actionable), in which the type of recommendations (e.g., implement change in drug regimen, monitor drug therapy) were dependent upon the clinical situation of each individual patient. From the study sample, 165 (82.5%) participants had actionable drug–gene pairs. In total, there were 429 drug–gene pairs, including 158 (36.8%) that were clinically actionable, and 62 (14.5%) that were either potentially or possibly actionable during consultations. Overall, 118 participants comprised the analytical sample, representing 220 actionable drug–gene pairs or 1.9 per participant.
The majority (70.5%) of pharmacists’ recommendations were accepted by PACE prescribers. Monitoring drug therapy accounted for the highest frequency (24.1%) of recommendations, followed by consider drug regimen change (20.5%). The percentage of recommendations to implement a change in drug regimen, drug dosage, or time of administration adjustment was 34.1%, and these were accepted roughly one-third of the time.
Cost avoidance, defined as “the economic consequences that would have occurred in the absence of pharmacist recommendations,” was determined by using calculated estimates from previous studies and adjusted to account for inflation. These studies estimated cost avoidance by assessing the cost of the original drug therapy (i.e., prior to recommended change) and the cost of the recommended drug therapy in the context of drug acquisition cost, drug therapy duration, pharmacist labor cost, and probability of harm. By performing PGx testing as an additional component to the traditional medication review for participants enrolled in PACE, the estimated cost avoidance was more than $230,000 when all recommendations were included. However, based on acceptance rates, the conservative cost avoidance was approximately $160,000. This represents an estimated cost avoidance per actionable drug–gene pair of $1000 or $2000 per participant. Overall, there is substantial cost that can be avoided when incorporating PGx.
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