The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy

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.

Keywords: :

• Pharmacogenetic testing
• Health resource utilization
• Drug metabolizing enzymes
• Drug interactions
• Adverse drug events
• Polypharmacy
• Geriatrics
• Cytochrome
• CYP2D6
• CYP2C9
• CYP2C19
• CYP3A4
• CYP3A5

Transparency

Declaration of funding

Genelex provided services consisting of buccal swab collection materials, shipping, genotyping and curation of the YouScript report. Data analysis by the University of Utah was funded through an unrestricted research grant.

Declaration of financial/other relationships

TM and KA are employees and potential equity holders of Genelex. JME peer reviewers were paid for their time.

Acknowledgments

The authors would like to acknowledge RPM Alliance (San Diego, CA), and Ranjit Thirumaran, Richard Newman, and Jarrod Heck, Genelex, for editing and study management, and Ben Yu from the University of Utah for his data programming contributions.