Improving Care, Reducing Waste

February 21, 2017 Ian McCrae

The cost of healthcare is rising, and so too is the amount spent on treatments that are ineffective—or worse, potentially harmful.

Precious healthcare dollars are being wasted because healthcare professionals currently don’t have access to—or a way to understand—comprehensive patient records that contain genetic, environmental, and social information.

A PwC Health Research Institute report estimates that wasteful spending in the U.S. health system totaled up to $1.2 trillion of the $2.2 trillion spent nationally.

That cost is being borne by citizens through their taxes and their insurance premiums.

A significant moment during which waste and lost opportunity occurs is when the wrong drugs are prescribed, which is why the discipline of pharmacogenomics is so central to the practice of precision medicine. Simply put, pharmacogenomics uses a person’s genetic makeup to determine which medications will work best for that person.

Research has shown that less than 50% of the population metabolizes drugs in what is considered a “normal” way, and yet most individuals receive the same medications in similar doses regardless of their individual needs.

For example, by having my genome mapped, I’ve discovered that I am what’s referred to as an ultra-fast metabolizer of a significant number of drugs, which can result in toxicity with prodrugs and reduced activity with active drugs. It means that a lot of medications just don’t work for me, or the side-effects are unmanageable. If I fall seriously ill, the drugs I am prescribed may be ineffective and therefore a waste of money.

That’s a bad outcome for me. That’s an expensive outcome for the people who pay for my care—in New Zealand, Australia, and Europe, that’s likely to be the government; in the U.S., that’s likely to be a health insurance company.

What if that cost was instead put into predicting a person’s response to drugs by mapping their genome? 
It currently costs about $1,000, and it’s getting cheaper every day. In addition, targeted pharmacogenomics testing can be performed for around $150. Soon it will not be unusual for people to have their genome mapped, and the data will become an essential part of their electronic health records (EHR).

Armed with information about an individual’s genetic makeup, clinicians will be better able to prescribe the best medication—in the right doses and in the right combination—to suit the exact condition of the patient.

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To learn more about pharmacogenomics, please download Volume 2 of Orion Health’s special series on precise health.

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