title: Implementation of Pharmacogenetic Testing Within the Veterans Health Administration From 2011 to 2013.
abstract: We assessed implementation of precision medicine within the Veterans Health Administration. We analyzed the use of interleukin-28B (IL28B) pharmacogenetic test, which predicts interferon-α treatment response in patients with hepatitis C. Patients with favorable CC genotype exhibit a two-fold higher response than patients with less favorable genotypes (CT and TT). Linking IL28B tests to Veterans Health Administration clinical data, we analyzed test use, concordance with guidelines, subsequent interferon-α treatment, and site variations. From January 2011 until December 2013, 3,529 Veterans underwent IL28B testing. There were 2,988 (85%) tests linked to electronic health record data. Demographics in those with clinical data: 97% male, mean age 59 years (SD 6.8), race: White 50%, Black 43%, Hispanic 3%, and other 3%. In Whites, the favorable CC genotype was three-fold more prevalent (541, 36%) than in Blacks (151, 12%). Analysis of IL28B timing revealed 2,373 (79%) Veterans were appropriately tested before interferon-α, 49 (2%) tested concurrent with interferon-α, and 566 (19%) tested post interferon-α treatment. Of the 630 treatment-naïve Veterans with CC genotype, only 144 (23%) initiated interferon-α treatment post-testing. Although 35% of IL28B tests overall did not influence care, the majority of tests were guideline concordant and clinically useful. IL28B testing varied substantially by site and state.
authors.affiliation: VA Salt Lake City Health Care System, 500 Foothill Boulevard, Salt Lake City, UT 84148.
authors.forename: Julie
authors.initials: J
authors.lastname: Lynch
authors.affiliation: VA Salt Lake City Health Care System, 500 Foothill Boulevard, Salt Lake City, UT 84148.
authors.forename: Scott L
authors.initials: SL
authors.lastname: DuVall
authors.affiliation: RTI International, 307 Waverley Oaks Road, Waltham, MA 02452.
authors.forename: Brygida
authors.initials: B
authors.lastname: Berse
authors.affiliation: Veterans Health Administration, 810 Vermont Avenue Northwest, Washington, DC 20420.
authors.forename: Angela
authors.initials: A
authors.lastname: Whatley
authors.affiliation: Veterans Health Administration, 200 Springs Road, Bedford, MA 01730.
authors.forename: Cathy
authors.initials: C
authors.lastname: St Pierre
authors.affiliation: Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710.
authors.forename: Omobonike
authors.initials: O
authors.lastname: Oloruntoba
authors.affiliation: Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hunt
mesh_terms: D005260:Female; D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use; D007372:Interferons; D007378:Interleukins / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D000071185:Pharmacogenomic Testing / Q000379:methods*; D016730:Program Development / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans / Q000706:statistics & numerical data*; D000095022:Interferon Lambda
chemical_list: D016898:Interferon-alpha; D007372:Interferons; D007378:Interleukins; C000624353:interferon-lambda, human; D000095022:Interferon Lambda