Economic evaluation of a pharmacogenomic multi-gene panel test to optimize anti-hypertension therapy

simulation study

Eli F. Kelley, Eric M. Snyder, Nimer S. Alkhatib, Scott C. Snyder, Ryan Sprissler, Thomas P. Olson, Monica K. Akre, Ivo L Abraham

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Aims: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for ∼360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon. Materials and methods: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events. Results: Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental genetic testing costs of $2,355,540,000. This represents total 3-year savings of $42,276,736,216, or a 47% reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient. Conclusions: A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47%, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89% of these savings are generated by averting specific adverse events and, thus, optimizing choice of therapy in function of both safety and efficacy.

Original languageEnglish (US)
JournalJournal of Medical Economics
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pharmacogenetics
Cost-Benefit Analysis
Hypertension
Costs and Cost Analysis
Genes
Genetic Testing
Therapeutics
Genotype
Safety
Precision Medicine
Standard of Care
Antihypertensive Agents
Blood Vessels
Cardiovascular Diseases
Economics
Kidney
Drug Therapy
Research

Keywords

  • Economics
  • Genetic testing
  • Hypertension
  • Pharmacogenomics
  • Precision medicine
  • Simulation

ASJC Scopus subject areas

  • Health Policy

Cite this

Economic evaluation of a pharmacogenomic multi-gene panel test to optimize anti-hypertension therapy : simulation study. / Kelley, Eli F.; Snyder, Eric M.; Alkhatib, Nimer S.; Snyder, Scott C.; Sprissler, Ryan; Olson, Thomas P.; Akre, Monica K.; Abraham, Ivo L.

In: Journal of Medical Economics, 01.01.2018.

Research output: Contribution to journalArticle

Kelley, Eli F. ; Snyder, Eric M. ; Alkhatib, Nimer S. ; Snyder, Scott C. ; Sprissler, Ryan ; Olson, Thomas P. ; Akre, Monica K. ; Abraham, Ivo L. / Economic evaluation of a pharmacogenomic multi-gene panel test to optimize anti-hypertension therapy : simulation study. In: Journal of Medical Economics. 2018.
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abstract = "Aims: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for ∼360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon. Materials and methods: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events. Results: Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental genetic testing costs of $2,355,540,000. This represents total 3-year savings of $42,276,736,216, or a 47{\%} reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient. Conclusions: A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47{\%}, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89{\%} of these savings are generated by averting specific adverse events and, thus, optimizing choice of therapy in function of both safety and efficacy.",
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AU - Snyder, Scott C.

AU - Sprissler, Ryan

AU - Olson, Thomas P.

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AU - Abraham, Ivo L

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AB - Aims: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for ∼360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon. Materials and methods: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events. Results: Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental genetic testing costs of $2,355,540,000. This represents total 3-year savings of $42,276,736,216, or a 47% reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient. Conclusions: A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47%, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89% of these savings are generated by averting specific adverse events and, thus, optimizing choice of therapy in function of both safety and efficacy.

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KW - Hypertension

KW - Pharmacogenomics

KW - Precision medicine

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