The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy |
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Authors: | D. Brixner E. Biltaji A. Bress S. Unni X. Ye T. Mamiya |
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Affiliation: | 1. Department of Pharmacotherapy, College of Pharmacy, and Program in Personalized Health, University of Utah, Salt Lake City, UT, USAdiana.brixner@utah.edu;3. Department of Pharmacotherapy, College of Pharmacy, and Program in Personalized Health, University of Utah, Salt Lake City, UT, USA;4. Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA;5. Genelex Corporation, Seattle, WA, USA |
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Abstract: | Objective:To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients.Methods:An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources.Results:There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR?=?0.61, 95% CI?=?0.39–0.95, p?=?0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR?=?0.29, 95% CI?=?0.15–0.55, p?=?0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR?=?1.97, 95% CI?=?1.74–2.23, p?0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR?=?1.47, 95% CI?=?1.32–1.64, p?0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations.Conclusion:Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate. |
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Keywords: | Pharmacogenetic testing Health resource utilization Drug metabolizing enzymes Drug interactions Adverse drug events Polypharmacy Geriatrics Cytochrome CYP2D6 CYP2C9 CYP2C19 CYP3A4 CYP3A5 |
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