Effect of ambiguous hemochromatosis gene test results on physician utilization.
BACKGROUND
Genetic test results may be available to greater numbers of people through genetic screening projects and other means. The effects of widespread genetic testing and notification of genetic test results, particularly added costs through increased physician utilization, have not been clearly established.


METHODS
A primary care-based cohort of 20,306 participants (Hemochromatosis and Iron Overload Study, Ontario site) were tested for the C282Y and H63D mutations of the HFE gene and for abnormal serum ferritin (SF) and transferrin saturation levels. The primary outcome variable was the total number of physician claims per patient after genetic test notification by mail. Multiple Poisson regression was used to adjust for age, sex, baseline SF, diagnoses of arthritis, diabetes, heart failure and impotence, self-rated health, and the number of claims during the 12 months before notification of results. The reference group had no HFE mutations (wild type) and normal transferrin saturation/SF values.


RESULTS
Participants with an ambiguous hemochromatosis gene test and normal iron levels had statistically significantly higher average physician utilization of 3.0%. Participants with HFE mutations (excluding C282Y homozygotes) and elevated iron values showed a 6% increase in physician utilization.


CONCLUSIONS
The health effects, if any, of increased utilization in heterozygotes or those with mild ferritin elevations are unknown but are unlikely to be large at the population level. Ambiguous genetic test results are associated with increased physician service use and should be considered when assessing the complete societal costs of widespread genetic testing.
Department of Epidemiology, University of Western Ontario, London, Canada.
Mark
M
Speechley
David
D
Alter
Helen
H
Guo
Helen
H
Harrison
Paul C
PC
Adams
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D005817:Genetic Counseling / Q000706:statistics & numerical data; D005820:Genetic Testing / Q000706:statistics & numerical data*; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I / Q000235:genetics*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D019190:Iron Overload / Q000097:blood; D008297:Male; D008565:Membrane Proteins / Q000235:genetics*; D008875:Middle Aged; D009154:Mutation; D009864:Ontario; D010820:Physicians / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014168:Transferrin / Q000032:analysis
C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D014168:Transferrin; D005293:Ferritins