Economic evaluation of a pharmacogenomic multi-gene panel test to optimize anti-hypertension therapy: simulation study

Abstract

Aims: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for $360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon. Materials and methods: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events.

Pharmacogenomics in Hypertension: Where We Stand Today

“…Reaching expert consensus in clinical guidelines requires weighing clinical benefits, potential adverse effects, and cost. While billion/year [111]. While this expectation appears straightforward, demonstration of such improved outcomes in clinical trials would be a powerful stimulus to bring pharmacogenomics into clinical use in patients with HTN.…”

The Future of Pharmacogenetics in the Treatment of Hypertension

“…Better BP control would lead to fewer cardiovascular and renal complications, and improvement in quality of life and longevity in our hypertensive patients. Given the vast numbers of patients with HTN, this could as well result in enormous cost savings, with one recent economic analysis estimating national cost savings of $42 billion over a 3-year period for 10 million insured patients [17]. Demonstration of such improved outcomes in clinical trials would be a powerful stimulus to bring pharmacogenomics into clinical use in patients with HTN and fulfill the promise of personalized medicine.…”

Is Precision Medicine Consistent With Primary Care?

“…Precision medicine is in the process of identifying many relevant DNA and RNA regions that predict response to a variety of medications, including those used to treat blood pressure, cancer, pain, asthma, and more. [12][13][14] The tools need further development and the ability to access results in a timely manner. When that occurs, the new era will arrive.…”