Benefits to Skilled Nursing Facilities
Significant research has been conducted on pharmacogenomics and its impact. Following are three key areas where pharmacogenomics testing can make a difference for facilities and their residents, backed by published studies.
Fewer Adverse Drug Events
One in ten long-term care residents experiences a medication-related adverse event within the first 30 days. Adverse drug events are a major cause of readmissions, a measure watched closely by Medicare. Adverse drug events also drive emergency room visits, which are an important cause of morbidity, particularly among residents greater than or equal to 65 years.
While not every adverse drug event is preventable by pharmacogenomics, the testing can help reduce the likelihood of ADEs by revealing the potential for some of the biggest risks: ineffective drugs, improper dosing, and harmful drug-drug interactions. A recent large multicenter prospective study in which individuals underwent a 12 gene pharmacogenomic panel test, there was a 30% lower risk of having an ADR for residents who had undergone pharmacogenomic testing.
Another study of healthcare utilization in elderly patients found that the rate of hospitalization was reduced from 16% to 10% when pharmacogenomics was employed while the rate of emergency department utilization dropped from 15% to 4%.
CASE IN POINT: Warfarin, a blood thinner toxic in high doses, leads to more drug-related emergency room visits by the elderly than any other prescription. Yet it can also reduce the chance of forming life-threatening blood clots, particularly in immobilized residents with cardiovascular risk factors. In a clinical trial that compared outcomes in 1,650 patients with a mean age of 72.1 years who had elective knee or hip arthroplasty and took warfarin to prevent blood clots, warfarin dosing guided by pharmacogenomics rather than by clinical recommendations reduced the risk of major bleeding, blood clots, venous thromboembolism, and death from 14.7% to 10.8%.
Increased Cost Savings
In long-term care settings, pharmacogenomics can provide residents and physicians with better drug choices, resulting in significantly reduced real-world costs through deprescribing, particularly among the 40% of the elderly who take five or more prescription drugs
One study of residents at long-term care facilities in Phoenix taking five or more medications focused on cost savings generated by three impacts of pharmacogenomics – replacing poorly suited medication, taking patients off medications likely to be incompatible or ineffective, and consolidating two medications into one. It resulted in the elimination and/or replacement of one to three drugs for 50% of the polypharmacy resident population tested, with an estimated $621 in annual savings per resident.
In addition, pharmacogenomics can reduce high costs related to treatment failures by offering an affordable alternative to trial and error.
Better Outcomes
A 2017 study found that four out of five patients carry at least one genetic variant that may affect response for commonly prescribed drugs. By understanding variations in genes that can affect drug response, pharmacogenetic testing can enhance treatment outcomes by revealing opportunities to improve a resident’s medication efficacy, tolerability, and safety. Predicting the most favorable drug response for a specific individual can guide treatment decisions and avoid a resident having to try multiple drugs before they are effectively treated and achieve improvement, thereby limiting prolonged suffering, especially for those residents with chronic conditions.
Since about one-third to one-half of all patients in the U.S. do not take their medications as directed because they feel the drugs do not work or suffer from negative side effects, pharmacogenomics can also help set the stage for personalized interventions that may reduce medication non-adherence by enhancing patient understanding of the genetic likelihood of having a positive therapeutic response or not having an adverse effect.
1 in 5 long-term care residents experience a medication-related adverse event within the first 30 days.
-Centers for Medicaid & Medicaid Services