The Effect of Pharmacogenetic Profiling With a Clinical Decision Support Tool on Healthcare Resource Utilization and Estimated Costs in the Elderly Exposed to Polypharmacy

J Med Econ. 2016;19(3):213-28. doi: 10.3111/13696998.2015.1110160. Epub 2015 Nov 11.

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

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Aged
  • Cytochrome P-450 Enzyme System / genetics*
  • Decision Support Systems, Clinical*
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Care Costs*
  • Health Resources / economics*
  • Health Resources / statistics & numerical data*
  • Hospitalization / economics
  • Humans
  • Male
  • Pharmacogenetics*
  • Polypharmacy*
  • Propensity Score
  • Prospective Studies

Substances

  • Cytochrome P-450 Enzyme System