The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy
The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy
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DOI：
10.3111/13696998.2015.1110160
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发表时间：
2016-03-03
影响因子：
2.4
通讯作者：
Biskupiak, J.
中科院分区：
文献类型：
--
作者：
Brixner, D.;Biltaji, E.;Biskupiak, J.
目的：比较医疗资源利用（HRU）和临床决策的老年患者的基础上细胞色素P450（P450）药物遗传学检测和使用一个全面的药物管理临床决策支持工具（CDST），一个队列的类似non-tested patients.Methods：一项观察性研究比较了一个前瞻性队列的患者>= 65年进行药物遗传学检测的倾向评分（PS）匹配的历史队列的未测试的患者在索赔数据库。患者在入组时接受了61种口服药物中至少一种的处方药物或剂量变化或≥ 3种药物的组合。四个月HRU结果检查包括住院，急诊科（艾德）和门诊访问和供应商接受的测试建议。费用估计使用国家数据sources.Results：有205测试患者PS匹配820未经测试的患者。试验组的住院率为9.8%，未试验组为16.1（RR = 0.61，95% CI = 0.39-0.95，p = 0.027），试验组的艾德访视率为4.4%，未试验组为15.4%（RR = 0.29，95%CI = 0.15-0.55，p = 0.0002），门诊就诊率试验组为71.7%，未试验组为36.5%（RR = 1.97，95%CI = 1.74-2.23，p < 0.0001）。试验组的总体HRU发生率为72.2%，未试验组为49.0%（RR = 1.47，95%CI = 1.32-1.64，p < 0.0001）。测试组的潜在成本节约估计为218美元（平均值）。供应商大多数（95%）认为测试有帮助，46%遵循CDST提供的recommends.Conclusion：患者DNA测试和治疗根据个性化的处方系统有显着减少住院和急诊科就诊，从而节省潜在的成本。供应商对该系统的临床实用性有很高的满意度，并在适当的时候遵循建议。
Objective:To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients.Methods:An observational study compared a prospective cohort of patients >= 65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of >= 3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources.Results:There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR = 0.61, 95% CI = 0.39-0.95, p = 0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR = 0.29, 95% CI = 0.15-0.55, p = 0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR = 1.97, 95% CI = 1.74-2.23, p < 0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR = 1.47, 95% CI = 1.32-1.64, p < 0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations.Conclusion:Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.