Could Preemptive Pharmacogenomic Testing Emerge as an MTM Best Practice?

FEBRUARY 02, 2016
Blair Green Thielemier, PharmD
Advancement in DNA testing is occurring at an astonishing rate. Genetic lab testing companies are reimagining the data gathered by the Human Genome Project in exciting new ways. The Human Genome Project was a $3-billion endeavor started in 1990. It was expected to take 15 years to complete, but due to technologic advances, finished in 13 years.
President Clinton passed legislation in 2000 that prevented the patenting of the genome sequence. Although this move cost drug companies an estimated $50 billion, it allowed researchers to freely access the sequence data. Modern technology is now making genomic testing possible for a fraction of the time and cost. Genotype testing can now be completed through a noninvasive cheek swab and the results can be analyzed in 3 to 5 business days.
Genetic testing has come a long way since completion of the project. Now pharmacists and physicians can use pharmacogenomic test results to help choose safer and more effective medications for their patients. An article recently posted on Crain’s Chicago Business website featured a physician clinic in Illinois that is doing preemptive genotyping: NorthShore University’s HealthSystems clinic is building a program that will screen patients and use DNA test results to guide therapies.1
Another recent study, this one published in the Journal of Medical Economics and conducted at the University of Utah, used cytochrome P450 pharmacogenetic profiling in clinical decision making for elderly patients. The study results found that the hospitalization rate of the genotype-tested group was 6.3 percentage points lower than the untested cohort: 9.8% versus 16.1%, respectively. The estimated potential cost savings was $218 (mean) in the genotype-tested group.2 The study also found that among the health care providers of the genotype-tested group, 95% of providers found the test “helpful” and 46% followed the clinical decision support tool recommendations for therapy changes. The Mayo Clinic is conducting similar studies on the effectiveness of preemptive genotyping, developing clinical decision-making support tools of its own and planning integration of test results into its electronic medical record (EMR).3
These studies show the promising opportunities that exist within the field of pharmacogenomic testing. Pharmacy can take advantage of this new opportunity. Pharmacists are undoubtedly the pharmacokinetic experts and the most educated health care providers in regard to the cytochrome P450 system. Preemptive genotyping would make a nice addition to a pharmacy’s list of service offerings and point-of-care testing panel.