title: Pharmacogenomic and pharmacogenetic-guided therapy as a tool in precision medicine: current state and factors impacting acceptance by stakeholders.
abstract: Pharmacogenetic/pharmacogenomic (PGx) testing is currently available for a wide range of health problems including cardiovascular disease, cancer, diabetes, autoimmune disorders, mental health disorders and infectious diseases. PGx contributes important information to the field of precision medicine by clarifying appropriate treatments for specific disease subtypes. Tangible benefits to patients including improved outcomes and reduced total health care costs have been observed. However, PGx-guided therapy faces many barriers to full integration into clinical practice and acceptance by stakeholders, whether practitioner, patient or payer. Each stakeholder has a unique perspective on the role of PGx testing, although all are similarly challenged with demonstrating or appraising its cost-to-benefit value. Coverage by insurers is a critical step in achieving widespread adoption of PGx testing. The acceleration of adoption of precision medicine in general and for PGx testing in particular will be determined by how quickly robust evidence can be accumulated that shows a return on investment for payers in terms of real dollars, for clinicians in terms of patient clinical responses, and for patients in terms of economic, health and quality of life outcomes. Trends in PGx testing utilization and uptake by payers in real-world practice are discussed; the role of pharmacoeconomics in assessing cost-effectiveness is highlighted using a case study in psychiatric care, and several issues that will affect adoption of PGx testing in the United States (US) over the next few years are reviewed.
authors.affiliation: Symphony Health Solutions,Horsham,PA,USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Hess
authors.affiliation: Independent Researcher,Harleysville,PA,USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Fonseca
authors.affiliation: Genomind, Inc.,King of Prussia,PA,USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scott
authors.affiliation: Genomind, Inc.,King of Prussia,PA,USA.
authors.forename: Jesen
authors.initials: J
authors.lastname: Fagerness
mesh_terms: D003362:Cost-Benefit Analysis; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005820:Genetic Testing / Q000191:economics / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D010346:Patient Care Management / Q000191:economics / Q000379:methods; D010597:Pharmacogenetics / Q000191:economics / Q000379:methods*; D057285:Precision Medicine / Q000191:economics / Q000379:methods*