Genetic testing and pharmacogenomics: issues for determining the impact to healthcare delivery and costs.
OBJECTIVE
To determine the potential impact of genetic testing and pharmacogenomics on healthcare delivery and costs.


METHODS
Literature review.


METHODS
We examined 3 examples: (1) BRCA1/2 testing for breast cancer risk, (2) HER2/neu overexpression testing to guide drug treatment in women with breast cancer, and (3) CYP2C9 testing before the use of the anticoagulant warfarin. We discussed each genetic testing example from the perspective of the patient, provider, insurer, industry, government, and society.


RESULTS
The expanded use of genetic information offers many potential clinical benefits, but also many economic challenges. One of those challenges will be managing the impact of genetic testing on healthcare delivery and costs.


CONCLUSIONS
Systematic, evidence-based technology assessments and economic evaluations will have to be used to guide the incorporation of genomics into clinical practice. More research also will be needed to assess patient preferences and willingness to pay for genomic technologies; how providers can assess and use genomic technologies; and how the industry, insurers, and government can best balance the relevant costs and benefits.
Program in Pharmacogenomics and Population Screening, School of Pharmacy, Institute for Health Policy Studies, and UCSF Comprehensive Cancer Center, University of California, San Francisco, 94143, USA. kathryn@itsa.ucsf.edu
Kathryn A
KA
Phillips
David L
DL
Veenstra
Scott D
SD
Ramsey
Stephanie L
SL
Van Bebber
Julie
J
Sakowski
D001943:Breast Neoplasms / Q000235:genetics; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005820:Genetic Testing; D006302:Health Services Research; D006801:Humans; D008329:Managed Care Programs; D010597:Pharmacogenetics; D014481:United States; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin