Assessment of a Manual Method versus an Automated, Probability-Based Algorithm to Identify Patients at High Risk for Pharmacogenomic Adverse Drug Outcomes in a University-Based Health Insurance Program

Abstract

We compared patient cohorts selected for pharmacogenomic testing using a manual method or automated algorithm in a university-based health insurance network. The medication list was compiled from claims data during 4th quarter 2018. The manual method selected patients by number of medications by the health system’s list of medications for pharmacogenomic testing. The automated method used YouScript’s pharmacogenetic interaction probability (PIP) algorithm to select patients based on the probability that testing would result in detection of one or more clinically significant pharmacogenetic interactions. A total of 6916 patients were included. Patient cohorts selected by each method differed substantially, including size (manual n = 218, automated n = 286) and overlap (n = 41). The automated method was over twice as likely to identify patients where testing may reveal a clinically significant pharmacogenetic interaction than the manual method (62% vs. 29%, p < 0.0001). The manual method captured more patients with significant drug–drug or multi-drug interactions (80.3% vs. 40.2%, respectively, p < 0.0001), higher average number of significant drug interactions per patient (3.3 vs. 1.1, p < 0.0001), and higher average number of unique medications per patient (9.8 vs. 7.4, p < 0.0001). It is possible to identify a cohort of patients who would likely benefit from pharmacogenomic testing using manual or automated methods.

Pharmacogenetic testing in primary care could bolster depression treatment: A value proposition

“…9 Several implementation studies on pharmacogenetic testing have been conducted, 8,[10][11][12][13][14][15] and some specifically for psychiatric medications. [16][17][18][19][20] While prescribers have begun to use pharmacogenetic testing in routine care in different specialties, widespread adoption has lagged both across and within institutions: analysis of administrative claims for Medicare and Medicaid in one US state found that only 4.4% of Medicaid beneficiaries and 10.5% of Medicare beneficiaries who had begun a prescription of a medication included in the FDA table of drugs with pharmacogenetic testing information on the label actually received pharmacogenetic testing. 21 Prior work has shown that a multitude of factors, from individual prescriber to larger structural issues, are barriers to pharmacogenetic testing adoption.…”

“…However, realizing benefits from pharmacogenetic testing in real‐world practice will depend on the extent to which prescribers value and use it 9 . Several implementation studies on pharmacogenetic testing have been conducted, 8,10–15 and some specifically for psychiatric medications 16–20 . While prescribers have begun to use pharmacogenetic testing in routine care in different specialties, widespread adoption has lagged both across and within institutions: analysis of administrative claims for Medicare and Medicaid in one US state found that only 4.4% of Medicaid beneficiaries and 10.5% of Medicare beneficiaries who had begun a prescription of a medication included in the FDA table of drugs with pharmacogenetic testing information on the label actually received pharmacogenetic testing 21 .…”