Health Economics

Benefit of Precision Medicine in Patient Care

Data Facilitates Treatment Decisions

  • Greater awareness of personal and family risk factors drives treatment discussions

  • Molecular companion diagnostics help physicians identify appropriate medical therapy

Health Economics Research

  • Breast Cancer

    First comprehensive economic study demonstrating cost effectiveness of EndoPredict.

    “Payers would benefit from understanding the financial implications of using gene expression tests to determine recurrence risk in women with early-stage breast cancer. Our study provides firm evidence validating the economic value of incorporating EndoPredict into patient care.”

    – Malek B. Hannouf, Ph.D., Lead Investigator

    Hannouf M, et al. Cost-effectiveness analysis of multigene expression profiling assays to guide adjuvant therapy decisions in women with invasive early-stage breast cancer. Pharmacogenomics J. 2020 Feb; 20(1):27-46.

  • Depression

    Prescribing that followed the test report was associated with significant cost savings.

    “Patients whose psychiatric medication treatment was congruent with the combinatorial pharmacogenomic test report saved $1061 CAD per member per year (PMPY) on prescription medication costs relative to patients whose medications were incongruent with their test report (p<0.0001).”

    Tanner JA, et al. Canadian medication cost savings associated with combinatorial pharmacogenomic guidance for psychiatric medications. ClinicoEconomics and Outcomes Research. 9 December 2019; 2019(11):779-87.

    For patients with MDD, individuals who received GeneSight had total costs of $18,741 compared to $24,971 in TAU arm representing total cost savings of $6,050.

    “From the perspective of managed care decision makers, as our results indicate, the use of CPGx offers clinicians and their patients the benefit of more precise selection of psychotropic drugs while offering cost savings to the health plan. Moreover, coverage of CPGx may yield material PMPM savings associated with spending on anxiety, depression and bipolar disorder and marginal PMPM savings associated with overall spending on psychiatric disorders. Since the test cost is a one-time investment, average savings are expected to increase as the duration is extended over the life cycle of psychiatric treatment.”

    Benitez J, et al. Use of combinatorial pharmacogenomic guidance in treating psychiatric disorders: financial impact on a health plan. Per Med 2018 Nov; 15(6):481-94.

    Healthcare utilization cost higher for patients using problematic medications compared to patients using better tolerated medications.

    “Subjects whose medication regimen included a medication identified by the gene-based interpretive report as most problematic for that patient and are in the ‘red bin’ (medication status of ‘use with caution and frequent monitoring’), had 69% more total health care visits, 67% more general medical visits, greater than three-fold more medical absence days, and greater than four-fold more disability claims than subjects taking drugs categorized by the report as in the green bin (‘use as directed’) or yellow bin (‘use with caution’).”

    Winner JG, et al. Psychiatric pharmacogenomics predicts health resource utilization of outpatients with anxiety and depression. Transl Psychiatry 2013 Mar 19; 3:e242.

    79% of clinicians made decisions congruent with report recommendations, reducing overall post-test medication costs and improving adherence.

    “Patients who received pharmacogenomic (PGx) testing saved $1035.60 in total medication costs (both CNS and non-CNS medications) over 1 year compared to the non-tested standard of care cohort (p = 0.007). PGx testing improved adherence compared to standard of care (ΔPDCCPGx = 0.11 vs ΔPDCTAU = −0.01; p < 0.0001). Pharmacy cost savings averaged $2774.53 for patients who were changed to a combinatorial pharmacogenomic (CPGx) congruent medication regimen, compared to those who were not (p < 0.0001).”

    Winner JG, et al. Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1 year prospective evaluation. Curr Med Res Opin 2015 Sep; 31(9):1633-43.

    CPGx improved treatment response rate by 70%, resulting in patient cost savings over lifetime.

    “CPGx improved the treatment response rate by 70% (1.7 times as high as that with TAU), increasing QALYs by 0.316 years. With these health benefits, CPGx is expected to save $3711 in direct medical costs per patient and $2553 in work productivity costs per patient over the lifetime. The cost-effectiveness of CPGx testing was robust over a wide range of variation in the input parameters, including the scenario when testing efficacy was set to its lower limit.”

    Hornberger J, et al. Cost-effectiveness of combinatorial pharmacogenomic testing for treatment resistant MDD patients. The American Journal of Managed Care 2015 August; 21(6):e357-65.

  • Hereditary Cancer

    Economic comparison of multigene panel or single syndrome (SS) testing

    “This study showed that overall healthcare utilization and costs were not different for patients who had panel or SS testing.”

    Byfield, SD. et al. Economic impact of multigene panel testing for hereditary breast and ovarian cancer. J Comp Eff Res. 2021 Feb;10(3):207-217.

    Quality assurance measures provide cost savings to payers.

    “As healthcare providers and patients become more aware of the importance of personal and family history risk factors for hereditary cancer syndromes, the demand for genetic testing will continue to increase. As such, working with a diagnostic laboratory that provides extensive clinical QA measures whose goal is to support the most clinically appropriate care, while simultaneously avoiding unnecessary healthcare spending, is critical to the success of personalized medicine.”

    Smith S, et al. Optimization of quality assurance to increase clinical utility and cost effectiveness of hereditary cancer testing. Per Med 2017; 14(3), 213-20.

  • Prenatal and Carrier Screening

    Carrier Screening

    Clinical impact and cost-effectiveness of a 176-condition expanded carrier screen.

    “Preconception ECS is predicted to reduce the burden of Mendelian disease in a cost-effective manner compared with minimal screening.”

    Beauchamp, K.A., Johansen Taber, K.A. & Muzzey, D. Clinical impact and cost-effectiveness of a 176-condition expanded carrier screen. Genet Med 21, 1948–1957 (2019).

  • Prostate Cancer

    Prolaris projected to reduce costs by $1,894 per patient tested over 3 years.

    “When adopted in patients classified by the American Urological Association as low or intermediate risk, the assay was projected to reduce costs…largely through the increased use of active surveillance.”

    Gustavsen G, et al. Health economic impact of a biopsy-based cell cycle gene expression assay in localized prostate cancer. Future Oncol. 2020 Sep 9. doi: 10.2217/fon-2020-0648. Online ahead of print.

    Potential cost savings to payers.

    “Savings are due to increased use of active surveillance in low− and intermediate−risk patients, but also from reduced progression rates in high−risk patients with more aggressive disease who transition to multi−modality therapy.”

    Crawford ED, Cole D, Lewine N, et al. Evaluation of the economic impact of the CCP assay in localized prostate cancer. Scientific poster presented at AUA-SCS 2015, ASCO-GU 2015, SUO 2014.

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