Drive approximately 125,000 hospital admissions<\/li>\n<\/ul>\nIn addition to causing additional discomfort and stress for those affected, these obviously drive up health care costs.<\/p>\n
Genotypes, Drug Metabolizing Enzymes (DMEs) and Drug Effectiveness<\/h2>\n
A less obvious problem is that the response to a medicine often depends on the genotype of the recipient.\u00a0 Most modern drugs are acted on by drug metabolizing enzymes (DMEs).\u00a0 Enzymes that fall into this group are required to clear the drug from the system or are required to convert a precursor molecule into a biologically active molecule.\u00a0 However, not all individuals are equipped with the same set of DMEs.\u00a0 Some individuals may completely lack functional copies of the enzymes needed to convert a drug precursor into the biologically active molecule, rendering the treatment ineffective.\u00a0 Some individuals may have enzymes with lower functional activity, meaning the precursor molecule is converted to functional drug at a lower rate, effectively lowering the dose of the treatment.\u00a0 Alternatively, individuals might have lower activity of the enzymes that degrade a drug, resulting in higher circulating concentrations of the biologically active molecule.\u00a0 Some individuals may convert a drug into a toxic product as a result of their inborn metabolism and others might be more sensitive to its side effects.<\/p>\n
Pharmacogenomics \u2013 Analyzing the Link Between DME Genotypes and Drug Metabolism<\/h2>\n
Pharmacogenomics is the field that analyzes the link between DME genotypes and drug metabolism.\u00a0 There is increasing interest among patients, medical practitioners, governmental health services and insurance providers to use pharmacogenomics to increase the effectiveness and safety of drug treatments.\u00a0 Finding the most effective, safe and economical treatment options involves making sure the recipient\u2019s genotype can metabolize the drug as intended.<\/p>\n
Using Pharmacogenomics to Optimize Administration of Medication<\/h3>\nSeeking Effective Treatments and Reducing Costs<\/h4>\n
Although modern medicines can be highly effective, they can also be expensive.\u00a0 In the US alone, spending on pharmaceutical treatments is around $350 billion annually (2).\u00a0 In the current climate of finding ways to decrease healthcare costs, it is therefore important to rapidly determine the treatment and dosage that treats the pathology most effectively.\u00a0 Recently, in an effort to reduce medical costs and provide a greater return on investment, a pilot program was initiated by the Teacher\u2019s Retirement System of Kentucky (TRSKY).\u00a0 The TRSKY is a pension fund serving 34,000 retirees, ranging in age from 65-107. \u00a0Seventy-five percent of members had high blood pressure or heart disease, 58% had high cholesterol, 50% had pain or inflammation, and they took an average of 15 prescriptions to help alleviate these and other conditions. \u00a0However, it was not clear that the prescription regimens that the members were on were safe, necessary, or that they would even work.\u00a0 Answering these questions could improve outcomes for the individuals, and by reducing unnecessary doctor\/hospital visits, reduce the overall costs for the fund.<\/p>\n
Teacher’s Retirement System of Kentucky (TRSKY) Pilot Program<\/h2>\nGeneticists, Doctors, and Pharmacists Working Together<\/h3>\n
To focus on improving medication safety and efficacy for its members, TRSKY collaborated with Coriell Life Sciences to utilize genetic testing and personalized therapy analysis delivered to physicians through expert pharmacist consultation.\u00a0 The study began by collecting more detailed medical information on about 5900 members who participated in the study.\u00a0 Initial analysis found that cutting potential misdirected medical spending on medications could potentially save over $16 million dollars.\u00a0 This increased efficiency included identifying patients taking the wrong dose, determining which patients should stop a medication, and notifying patients for which better alternatives were available.<\/p>\n
The second step was to collect genomic samples from the participants.\u00a0 Coriell Life Sciences sent out an at-home collection kit and extracted the genomic DNA from the returned kits at their laboratories.\u00a0 They then analyzed the genomic sequences, with particular attention paid to DME allele configurations and other pharmaceutically important loci.\u00a0 Once the results were generated, members then met with geneticists, doctors and pharmacists to explain the report and communicated to the individual members the medication action plan.<\/p>\n
Lower Hospitalizations, Reduced Hospital Admissions, Reduced Spending on Medications<\/h3>\n
Success was measured several ways.\u00a0 The study found that 57% of the participants could have their medical dose optimized, 33% had better alternative medicines, and 10% should stop taking one of their prescriptions entirely.\u00a0 Another metric was to track a factor called MA3:\u00a0 a measure of medication adherence, medication appropriateness, and medication adversity.\u00a0 After delivery of the Medication Action Plans, there was a 28% reduction in MA3-related risk incidents.\u00a0 Fiscally, there was a 17% reduction in cost-to-plan spending after 6 months, compared to a 2.5% increase in those who did not participate in the study.\u00a0 Finally, those who took actions based on their personalized medication action plan reported much improved performance efficacy of the drugs that were prescribed for them.<\/p>\n
Based on these results, the insurance underwriter for the TRSKY fund calculated that if they tested every member, they could expect a $21.7 million reduction in annual health care costs.\u00a0 Satisfaction with the results of the pilot study was indeed universal.<\/p>\n
Benefits of Preemptive Pharmacogenomics<\/h2>\nKnowing DME Genotypes Can Increase Medication Efficacy and Safety, Decrease Discomfort and Reduce Cost<\/h3>\n
This example shows the value of preemptive pharmacogenomics for controlling health care costs.\u00a0 In short, by knowing the patient\u2019s DME genotypes, the appropriate drug, correct dose, and biologically active version can be matched to the individual.\u00a0 In many cases, this information will increase efficacy, increase safety, decrease discomfort, and reduce costs.\u00a0 Pharmacogenomics therefore has enormous potential to improve the healthcare system for all participants.<\/p>\n
References<\/strong><\/p>\n\n- https:\/\/health.gov\/our-work\/health-care-quality\/adverse-drug-events#ref1<\/a><\/li>\n
- Rajkumar, SV. The high cost of prescription drugs: causes and solutions.\u00a0 Blood Cancer J. 10(6): 71 (2020).\u00a0 doi: 10.1038\/s41408-020-0338-x<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Pharmacogenomics to Increase the Effectiveness and Safety of Drug Treatments Reducing Health Care Costs With Pharmacogenomics: The Teacher\u2019s Retirement System of Kentucky (TRSKY) Story When we are sick, we seek relief as quickly as possible.\u00a0 Fortunately, medical science has developed an extensive pharmacopeia for treating a very large number of pathologies.\u00a0 Although popping a pill,<\/p>\n","protected":false},"author":120,"featured_media":15542,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_monsterinsights_skip_tracking":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[180],"tags":[1507],"division":[],"class_list":{"0":"post-15521","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-pharmacogenomics","8":"tag-predictive-genomics","9":"entry"},"_selected_authors":"","_selected_reviewers":"","acf":[],"yoast_head":"\n
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