What Is Pharmacogenomic Testing? Simply put, PGx can determine how each individual metabolizes nearly 95 percent of the most commonly prescribed oral medication, avoiding costly trial and error prescribing and minimizing the risk of costly and life-threatening Adverse Drug Reactions. Medically speaking, Pharmacogenomics (PGx) is the widespread study of the human genome, the application of that information to the study of drug response within individuals, and the use of that information to improve medication delivery.
Personalized pharmacogenomic evaluations reveal a patients' risks of serious side effects and reduced drug effectiveness prior to therapy, allowing doctors to make clinical decisions in prescribing that improve therapeutic outcomes. Most importantly, this breakthrough technology can improve the quality of life for your employees.
The Cost of Trial and Error Medicine
The U.S. alone spends nearly $1,000 per person per year on pharmaceuticals.
[i] The cost associated with reduced patient adherence was estimated to be over $250 billion in 2010. Polypharmacy, severe adverse drug reactions (SADRs) and readmissions resulting from trial-and-error medicine are also increasing the cost of healthcare and may be reduced when precision medicine initiatives are implemented throughout the patient journey.
Adverse drug events (ADEs), a close cousin to ADRs, are also a serious public health matter; each year it is estimated they result in 700,000 emergency department visits and 120,000 hospitalizations, attributing to $3.5 billion in extra medical costs.
[ii] Outside of the hospital setting, the CDC estimates that 40 percent of costs incurred by ADRs in ambulatory care settings are preventable.
[iii] The use of pharmacogenomic testing in establishing the correct drug/dose individualized for each patient will go a long way in improving patient compliance and potentially decrease adverse events across a number of common disease states.
Research has shown that adherent patients have a shorter duration of treatment and better outcomes resulting in an overall decreased cost of care.As we know, pain management is a public health problem affecting at least 100 million American adults.
[iv] Not only does pain impact more employees than cancer, diabetes and heart disease combined, but it is also the most common reason patients visit doctors, hospitals and health systems (pain alone accounts for 25 percent of all medical visits). Unfortunately, only 58 percent of your employees who take prescription pain medication receive adequate relief.
[v],[vi]The American Pain Society reports that untreated and undertreated chronic pain costs more than $600 billion a year in both medical costs and lost productivity ($261 - $300 billion for health care alone).
[vii] Pharmacogenomic testing has the ability to positively impact the treatment of many employees who require analgesic therapy and predict whether they will experience inadequate relief or an adverse event.
NSAIDS Therapy as a Replacement for Opioids
As the country is battling opioid addiction an alternative pain treatment in non-cancer patients is typically initiated with non-steroidal anti-in? ammatory agents like Tylenol 3 Non-steroidal anti-in? ammatory drugs (NSAIDs) are associated with much milder side effects when compared with opioids. A potential side effect of this solution for your employees is gastrointestinal bleeding- which is the adverse drug reaction associated with the most hospital admissions.
[viii] The use of NSAIDs has been associated with a seven-fold increase in the risk of gastrointestinal hemorrhage (GIH) for your employees; this relationship is dose-dependent. Prieto-Perez R and colleagues (2013) demonstrated that the half-life of celecoxib in CYP2C9*3/*3 patients was 2.7 times higher than those employees who were wild-type (CYP2C9*1/*1).
[ix] Considering this relationship and the fact that many NSAIDs are metabolized by CYP2C9,it is possible to predict employees who are at a higher risk for increased NSAID blood concentrations and therefore at increased risk for gastrointestinal bleeding complications. It is estimated that the cost burden associated with GI complications due to NSAIDs is more than $2.5 billion. Furthermore, it is estimated that GI bleeding results in 250,000 to 300,000 hospitalizations annually, each ranging from 2.7 to 15.2 days and costing between $3,402 and $23,207, depending on the type of bleed and complications.
[x],[xi],[xii]. Clearly, these tests can help prevent hospitalization as we seek an alternative to opioids.
What Can Pharmacogenomics Do For My Company?
Increased productivity, lower healthcare costs, and happier employees are just a few of the benefits of PGx that are backed up by research. Not only can PGx testing help in the treatment of pain In a 2013 study published in Translational Psychiatry researchers found that a PGx test for employees on at least one of 26 common antidepressant and antipsychotic medications could reduce total healthcare visits by 69 percent, medical-related absenteeism by greater than three-times, and four-times fewer disability claims.
Even without research, most employers agree that: With the right medication, employee symptoms are better treated and they're more productive at work, and back at work faster if they've been on short-term or long-term disability. Pharmacogenomics could prove, not only beneficial for employees but for employers and drug plan sponsors, as well. The bottom line is that your employees will be prescribed the optimal medication sooner, avoiding the often-costly trial and error process.
Through our alliance with our telemedicine partner WellVia we have developed a cost-effective streamlined method to deliver these tests to your employees in the comfort of their homes. The process is simple. An employee contacts WellVia for a consultation with a physician. The doctor determines if the test is medically necessary for that patient and the requisition is generated. This includes the medications the individual is currently taking to identify potential drug-to-drug interaction.
Covered by most Commercial Insurance Companies and Medicare, Predictive Medical confirms the benefits and ships the test to members home. The kit includes a swab used to gather saliva from an individual's cheek. The kit is shipped back to the laboratory for processing and the WellVia physician conducts a second outreach reach call to discuss the results of the tests.
The employee is provided the results and they can also be sent to their provider's office. The results include a wallet card that the employee can reference with their provider's when other medications are being prescribed.We believe these life-saving tests, when delivered through this cost-effective platform, will help promote better health for your employees while reducing your overall healthcare costs.
[i] Paris, V. (2014) Why Do Americans Spend So Much on Pharmaceuticals? PBS News Hour. Available from: http://www.pbs.org/newshour/updates/americans-spend-much-pharmaceuticals/
[ii] Medication Safety Basics. Centers for Disease Control and Prevention Medication Safety Program. Available from: http://www.cdc.gov/medicationsafety/basics.html
[iii] Mohan VB., Dervieux T. (2006). Overview of the pharmacoeconomics of pharmacogenetics. Pharmacogenomics. 7.8: 1175
[iv]http://www.painmed.org/patientcenter/facts_on_pain.aspx
[v] Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Institute of Medicine. 2012. Available from: http://iprcc.nih.gov/docs/032712_mtg_presentations/IOM_Pain_ Report_508comp.pdf
[vi] Peter D. Hart Research Associates, Americans Talk About Pain: A Survey among Adults Nationwide (August 2003):7Cantlupe J. Managing Patients Pain Improves Satisfaction, Revenue. 2013. Available from: http://www.healthleadersmedia.com/page-1/QUA-296771/Managing-Patients-Pain-Improves-Satisfaction-Revenue]
[vii] American Pain Society. Pain research funding inadequate in the face of soaring incidence and treatment costs. APS Press Room. May 10, 2013.
[viii] Estany-Gestal A, Salgado-Barreira A, Sanchez-Diz P, Figueiras A. (2011). In?uence of CYP2C9 genetic variants on gastrointestinal bleeding associated with nonsteroidal anti-in?ammatory drugs: a systemic critical review. Pharmacogenetics and Genomics. 21: 357- 64.
[ix] Prieto-Perez R et al. Evaluation of the relationship between polymorphisms in CYP2C8 and CYP2C9 and the pharmacokinetics of celecoxib. J Clin Pharmacol. 2013 Dec; 53(12):1261-7. Doi: 10.1002/jcph.169. Epub 2013 Sep 17
[x] Abdrabbo MK, Peura DA, Wilcox CM. (2006). NSAID- Associated GI Complications: Available Management Options and Identi?cation of High-Risk Patients. http://www.gastroendonews.com/download/ nsaid_gense05.pdf
[xi] Wilcox CM, Cryer BL, Henk HJ, Zarotsky V, Zlateva G. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting. Clinical and Experimental Gastroenterology. 2009: 2; 21-30.
[xii] Viviane A, Alan BN. Estimates of costs of hospital stay for variceal and nonvariceal upper gastrointestinal bleeding in the United States. Value Health. 2008 Jan-Feb; 11(1):1-3. Doi: 10.1111/j.1524
