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

Kelley EF1, Snyder EM2, Alkhatib NS3,4, Snyder SC2, Sprissler R2,4,5, Olson TP6, Akre MK2, Abraham I3,5,7,8.

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Abstract

AIMS:

Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the United States and responsible for approximately 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. We aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a three-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 three-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.

RESULTS:

Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental testing costs of $2,355,540,000. This represents a total 3-year savings of $276,736,216, or a 47% reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient.

CONCLUSIONS:

A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47%, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89% of these savings are generated by averting specific adverse events and thus optimizing choice of therapy in function of both safety and efficacy.