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Precision Medicine: Pharmacogenomics

posted June 2018

Written by Bryan A. Odegard, MBA, PMP, CSM
Principal, NDEON Consulting

The National Academy of Medicine (NAM) estimates there is $750 billion in wasteful healthcare spending annually. In fact, studies have shown that widely prescribed drugs are effective in only 25 to 60 percent of the population taking them. One of the key issues contributing to the problem is the common trial and error routine patients participate in to achieve the desired outcomes. Patients are prescribed a drug, it does not work, they get an increased dosage, or some other tweak to the prescription, with no improvement. They are then prescribed another drug with no improvement, or in some cases experience a worse outcome. The cycle continues until the patient finally finds a prescription that meets his or her needs. This routine is costly, ineffective, inefficient and does not consider critical patient factors.

Precision medicine using pharmacogenomics may be the prescription needed to change this. Precision medicine looks at the traits, genes, environment, and lifestyle of patients and customizes drug therapy to achieve the expected and desired outcomes. Pharmacogenomics is the study of how a person’s genetics and metabolism will influence a medication’s efficacy. Pharmacogenetic testing results can tell a prescriber and pharmacist what a patient can or cannot metabolize, what dosage is best, and/or what drug therapies they should or should not be prescribed. In addition, it may help in formulating a specific drug therapy that accounts for the patient’s biomarkers.

There are several pharmacogenetic lab tests already available. Costs vary depending on the specific therapeutic category, number of drugs covered, etc. Initial results have shown that 60 to 70 percent of patients with a pharmacogenetic test have required a dose adjustment and/or a change in medication after the initial prescription.

For precision medicine to become effective, and broadly adopted, it needs to be promoted, practiced, and become increasingly precise. As the healthcare industry explores how to shift away from one-size-fits-all medicine, towards personalized, precision treatment, there are several questions to consider:

  • What are the triggers for testing, targeted populations, and targeted therapeutic categories?
  • How is this information made available for prescribing physicians and at the point-of-sale for pharmacists?
  • How are environmental and patient lifestyle factors discovered, captured, and shared across the care continuum?
  • Are there risks to an individual once their DNA has been mapped?
  • Who owns the data and who controls access to this data?
  • What are the ethical and moral considerations?

Your thoughts and comments are welcomed as we continue exploring this promising path toward improving patient outcomes.

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