Promises better outcomes, quicker return to work, lowered costs
“It’s absolutely be going to become standard 10 to 20 years from now. No patient will want to take a new drug without having their genetic information beforehand.”
So says James Kennedy, who leads the Tanenbaum Centre for Pharmacogenetics in the Campbell Family Mental Health Research Institute at the Centre for Addiction and Mental Health (CAMH) in Toronto.
Pharmacogenetics testing is designed to tell medical professionals which treatments would work best inside a specific patient based on DNA.
Encouraging results from research
For CAMH, who completed a recent study on the effectiveness of this type of testing, pharmacogenetics shows great promise for patients with mental health problems, says Kennedy.
“It’s very helpful for antidepressant and anti-psychotic medications because we don’t have any biology tests. There’s no physical test, we have to rely on what the patient tells us that it helps to be guided by the pharmacogenetics because at least we know whether the patient is getting enough of the drug or too much because genetically a person can have extra copies of the gene, and it makes them break down the drug really fast, and it never gets into their brain.”
The study involved 276 patients who suffered from treatment-resistant depression. This indicated they had not improved after trying two or more antidepressant medications.
“One group of patients got genetic testing that measures various genes mostly in their liver, but some in their brain, to score them from a genetic point of view as to how likely it is that they will do well on a given medication, and whether or not they’ll have side effects. The clinical trial did not dictate what antidepressant they would get but rather the test guided the prescribing physician to choose,” says Kennedy.
The results found a 89 per cent increase in rates of remission, compared to the regular standard of care delivered, he says.
“This study showed that the test was particularly good at getting these difficult-to-treat patients that what every doctor, psychiatrist wants is to get the patient all the way to remission or better and back to work. So for the patients whose doctor prescribed the medication based on the genetic test, there was almost twice as many patients able to get all the way to better.”
Getting disabled employees back to work
But for benefits plans providers, can these types of testing be employed to quicker get people back to work from disability?
Yes, says Beneva, an insurance provider who recently began offering pharmacogenetic testing to its benefits clients.
After a pilot test was completed with BiogeniQ, a producer of the DNA tests, “we had pretty good results, people that are taking the tests we find that they come back to work earlier, and the cost of the test is not so high. It doesn’t take just a few days of recovery, it’s faster than before and we’d say financially, it’s better. We know that for an employee to be back to health quicker, it’s a big win,” says Éric Trudel, executive vice-president and leader, group insurance at Beneva in Quebec City.
“For the employers, they have the same goal that ultimately we all have the same goal in the benefits industry: we want employees getting back to work faster, we want employees that are at work and productive,” he says.
The overall costs of employee benefits are expected to rise, according to a recent roundtable discussion.
While these test results are promising for organizations looking to save money on drug costs and increase productivity, barriers remain to widespread implementation, according to Kennedy.
Currently, there are not enough studies to prove its true effectiveness, he says, “so, the scientific validation was still unclear.”
But one of the biggest barriers also revolves around physicians, says Kennedy.
“They’ve never been trained on this in med school, and it’s a new thing. They tend to be leery of choosing drugs based on this test that they don’t fully understand.”
Leeriness remains around technology
As well, there are patients themselves who don’t fully understand what the tests involve.
“’You’re going to take my DNA and store it and do research on it and, I don’t know what might happen. The RCMP might be charging me with some crime or something,’ and now people have these fears of the unknown around DNA,” says Kennedy.
However, at BiogeniQ the way they are implementing testing should assuage some fears around confidentiality.
“It’s very simple. So the kits area sent directly to the patient by BiogeniQ. [The employee] gives a saliva sample that is analyzed without any involvement from Beneva. After that it has analyzed in our lab, the lab sends the results to the attending physician so the info can be included in the treatment plans. The process is voluntary, and the results are totally confidential,” says Jean-François Rioux, COO and vice-president at BiogeniQ in Montreal.
And while this technology is still nascent, it offers a bright future for benefits costs, says Kennedy.
“Anytime something new is introduced this the medical system, it is very slow to take it up and that is the case for pharmacogenetics. Insurance companies, from a human resources perspective, to help patients get the test and to facilitate having the testing done, that’s going to get the patient back to work, it’s going to end in more milder depression.”
“This would reduce this presenteeism where people show up physically for work but mentally they can’t work and getting on the right medication with reducing the rate of side effects that’s going to help for sure,” he says.
