In 1962, health care expenditures made up just five percent of the nation’s gross domestic product. Fifty years later, those figures have more than tripled, with the expenses now making up 17 percent of the GDP – the highest rate of spending growth of any developed country in the world. In the face of that ballooning spending, Katrina Armstrong, MD, MSCE, chief of the division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania, suspects that the fast-growing field of genomics may be a source of meaningful cost savings.
Genomics is the study and testing of one person’s genes, as well as the interactions between those genes and with the subject’s environment. According to the Centers for Disease Control, genetic tests have been developed for more than 2,200 diseases, of which about 2,000 are now available for use in clinical settings.
Writing in the March 14 issue of the Journal of the American Medical Association (JAMA), Armstrong notes that despite being a new technology – and therefore often associated with higher health care costs – genomics can also be used to identify individuals who will show little or no benefit from a medical intervention, possibly because they have a low risk of suffering harm without the intervention, or because they will not benefit from the intervention. In either case, genetic testing could reduce the use of treatments that are unnecessarily expensive or that are unlikely to yield a benefit. The result is an overall cost reduction.
As an example, Armstrong cites the use of genomics in certain women with breast cancer. Those with low-risk scores as determined by gene testing do not benefit from a particular type of chemotherapy called adjuvant chemotherapy – the use of chemotherapy drugs after the main tumor has been removed to kill off any remaining small amounts of cancer in the body. Armstrong calculates that using genomics in this way could result in $400 million in savings in one year.
She also identifies other instances where genetic testing can be used to predict the response to expensive therapy, including those used for certain types of lung cancer and colorectal cancers.
“There is significant potential for using genomics to identify situations where some types of treatment won’t be helpful,” says Armstrong. “Not only would we generate savings, but we would also be able to identify more beneficial treatment options for patients.”
For this potential to be realized, Armstrong says that several steps must be taken. These include developing effective clinical decision support systems – computer software that assists physicians in determining which patients are best suited to which treatments – and adapting information technology systems so that genomic information can be stored securely and efficiently while remaining easily accessible to physicians. In addition, medical professional and patient advocacy organizations must develop guidelines for managing genomic information in ways that protect patients and their privacy.
And it will be necessary to make a blueprint for the best uses of genetic testing at the outset of a patient’s care, she says. Armstrong says, “Genomics can only generate savings if the aggregate cost of the genetic testing is lower than the cost of the medical treatment under consideration.”