Value of Pharmacogenetic Testing Assessed with Real-World Drug Utilization and Genotype Data
: Litonius, Kaisa; Kulla, Noora; Falkenbach, Petra; Kristiansson, Kati; Tarkiainen, E. Katriina; Ukkola-Vuoti, Liisa; Cajanus, Kristiina; Korhonen, Mari; Khan, Sofia; Sistonen, Johanna; Orpana, Arto; Lindstedt, Mats; Nyronen, Tommi; Perola, Markus; Turpeinen, Miia; Kyto, Ville; Tornio, Aleksi; Niemi, Mikko
Publisher: WILEY
: HOBOKEN
: 2024
: Clinical Pharmacology and Therapeutics
: CLINICAL PHARMACOLOGY & THERAPEUTICS
: CLIN PHARMACOL THER
: 117
: 1
: 278
: 288
: 11
: 0009-9236
: 1532-6535
DOI: https://doi.org/10.1002/cpt.3458
: https://doi.org/10.1002/cpt.3458
: https://research.utu.fi/converis/portal/detail/Publication/458655951
Implementation of pharmacogenetic testing in clinical care has been slow and with few exceptions is hindered by the lack of real-world evidence on how to best target testing. In this retrospective register-based study, we analyzed a nationwide cohort of 1,425,000 patients discharged from internal medicine or surgical wards and a cohort of 2,178 university hospital patients for purchases and prescriptions of pharmacogenetically actionable drugs. Pharmacogenetic variants were obtained from whole genome genotype data for a subset (n = 930) of the university hospital patients. We investigated factors associated with receiving pharmacogenetically actionable drugs and developed a literature-based cost-benefit model for pre-emptive pharmacogenetic panel testing. In a 2-year follow-up, 60.4% of the patients in the nationwide cohort purchased at least one pharmacogenetically actionable drug, most commonly ibuprofen (25.0%) and codeine (19.4%). Of the genotyped subset, 98.8% carried at least one actionable pharmacogenetic genotype and 23.3% had at least one actionable gene-drug pair. Patients suffering from musculoskeletal or cardiovascular diseases were more prone to receive pharmacogenetically actionable drugs during inpatient episode. The cost-benefit model included frequently dispensed drugs in the university hospital cohort, comprising ondansetron (19.4%), simvastatin (7.4%), clopidogrel (5.0%), warfarin (5.1%), (es)citalopram (5.3%), and azathioprine (0.5%). For untargeted pre-emptive pharmacogenetic testing of all university hospital patients, the model indicated saving 17.49 in direct healthcare system costs per patient in 2 years without accounting for the cost of the test itself. Therefore, it might be reasonable to target pre-emptive pharmacogenetic testing to patient groups most likely to receive pharmacogenetically actionable drugs.
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This study was supported by funding from the Ministry of Social Affairs and Health (Helsinki, Finland), the Sigrid Jusélius Foundation (Helsinki, Finland), Strategic Research Council (numbers 358415, 358417) and the State funding for university-level health research. K.L. was supported by grants from the Biomedicum Helsinki Foundation (Helsinki, Finland), the Finska Läkaresällskapet (Helsinki, Finland), and the Finnish Medical Foundation (Helsinki, Finland). N.K. was supported by the TYKS Foundation (Turku, Finland).
