Evaluation of the Potential Impact of Drug-Gene Interaction Risk (DGIR) on Health Resource Utilization (HRU) in an Elderly Population A. Bress1, S. Unni1, E. Biltaji1,2, X. Ye1, B. Yu1, T. Mamiya3, R. Sass3, J. Biskupiak1, D. Brixner1,2 1. College of Pharmacy, University of Utah, Salt Lake City, UT 2. Program in Personalized Health Care, University of Utah, Salt Lake City, UT 3. Genelex Corporation, Seattle, WA Poster Number: PIH61 Background Results • Genetic testing for drug metabolizing enzyme (DME) coding genes has the potential to optimize medication prescribing, dosing, monitoring, patient outcomes, health resource utilization (HRU), and costs1 • Elderly patients may realize a greater benefit from genetic testing as they are at higher risk for polypharmacy and adverse drug events2,3 Objectives • To assess the relationship between Drug-Gene Interaction Risk (DGIR) and HRU in elderly patients to evaluate the potential benefit from pharmacogenetic testing Table 1. Baseline Characteristics According to DGIR Score* Age, years (Mean [SD]) Age by category (n [%]) • • • • • • 75 (6) 17,953 (23) 70-74 18,342 (31) 23,300 (28) 9,295 (28) 21,171 (28) 75-80 11,829 (20) 17,105 (21) 7,397 (22) 17,507 (23) ≥80 10,620 (18) 17,827 (22) 8,350 (25) 20,331 (26) Male (n [%]) 25,467 (43) 29,605 (36) 14,391 (43) 33,650 (44) 14,942 (25) 21,396 (26) 8,767 (26) 18,931 (25) Race (n [%]) Caucasian African American Asian or Pacific Islander Hispanic/Latino 2,200 (4) 2,950 (4) 1,235 (4) 3,099 (4) 1,530 (3) 2,065 (3) 711 (2) 1,558 (2) 809 (1) 1,563 (2) 682 (2) 961 (1) Other Races 1,365 (2) 1,763 (2) 614 (2) 1,297 (2) 38,713 (65) 52,487 (64) 21,430 (64) 51,116 (66) 9,204 (15) 14,309 (17) 5,475 (16) 11,197 (15) 48,926 (82) 65,804 (80) 27,150 (81) 63,709 (83) Medicare MORE2 Age ≥65 years with continuous enrollment for ≥6 months prior to index date Index date was claim for ≥1 drug(s) with pharmacogenetic (PGx) evidence for DGIR from a predefined list of 55 single ingredient and 6 combination drugs by either: • Pharmacokinetic in vivo evidence • Pharmacodynamic evidence • FDA label/dosing guidance Taking at least 3 prescription drugs including ≥1 drug(s) with PGx evidence 75 (6) 8,397 (25) Commercial Inclusion Criteria 74 (6) High N=76,962 23,992 (29) Medicaid Other/Unknown 420 (1) 481 (1) 164 (0) 372 (0) 1,009 (2) 1,630 (2) 650 (2) 1,684 (2) * All groups may not add up to 100% due to rounding Figure 2. Distribution of DGIR Score Among Analysis Cohort* 35% 33% 31% 30% Percentage of Patients • 73 (6) Medium N=33,439 18,768 (32) Study Design, Data Source, and Timeline Historical cohort study using Inovalon’s Registry®, a healthcare data warehouse with national medical/pharmacy administrative claims Patient identification period: July 1, 2012 through March 31, 2013 Study outcomes: Counts of HRU during 9 months of follow-up post index date including all-cause hospitalization, emergency room visits, and clinic visits DGIR represents the probability of at least one significant drug-gene interaction warning based on the patient’s medications and U.S. gene frequencies. Poisson regression was used to test association between DGIR and HRU counts Low N=82,224 65-69 Unknown Insurance type (n [%]) Methods • Zero N=59,559 Variable 25% 24% 20% 15% 13% 10% 5% 0% Zero (Reference) Low (>0 - <20%) Medium (≥20 - <40%) High (≥40%) * All groups may not add up to 100% due to rounding Figure 3. Incident Rate Ratios for HRU by DGIR Score Compared to Zero DGIR* High DGIR -5%** Figure 1. Patient Identification Flow Chart Unique patients in Inovalon’s MORE2 Registry® (Jan 1, 2012 - Dec 31, 2013) n = 41,846,662 With continuous enrollment* (Jan 1, 2012 - Dec 31, 2013) n = 5,772,751 (13.8%) Age ≥65 years (Jan 1, 2012 - Dec 31, 2013) n = 1,185,239 (20.5%) Any claim for ≥ 1 drug(s) from predefined list (Jan1, 2012 – Dec 31, 2013 ) n = 602,336 (51%) Excluded n = 266,589 • Date trimming 8%** Medium DGIR 9%** Low DGIR -8% -6% -4% -2% 0% 2% 4% 6% 8% 10% 12% Percent Change in HRU Rate * Adjusted for age, gender, race, Charlson Comorbidity Index, and known drug-drug interactions. Overall difference in HRU was 3% more compared to the zero risk group. ** p<0.00001 • Invalid NDC Value Any claim for ≥ 1 drug(s) from predefined list (Jul 1, 2012 - Mar 31, 2013) (Index Date) n = 335,747 (56%) Excluded n = 83,563 • On <3 prescription drugs at index date On ≥3 prescriptions drugs (at least one of which is from predefined list) n = 252,184 (75%, Analysis Cohort) Limitations • Only patients that had NDC codes which could be linked to a drug name were included, which may introduce selection bias. • Genetic risk was estimated by potential drug-gene interaction. * Allowing for up to a 30-day gap References 1.Wu AC, Fuhlbrigge AL. Economic evaluation of pharmacogenetic tests. Clinical Pharmacology and Therapeutics 2008;84:272-4 2.Hajjar ER, Hanlon JT, Artz MB, et al. Adverse drug reaction risk factors in older outpatients. The American Journal of Geriatric Pharmacotherapy. Dec 2003;1(2):8289 3.Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy. Dec 2007;5(4):345-351 Conclusions • Elderly patients with DRIG risk had a 3% increase in HRU compared to patients with zero DRIG risk. • Low and medium DGIR risk groups were associated with increased rates of HRU. The high DGIR was associated with lower HRU rates. • High risk groups may have more commonly known drug interactions, which are aggressively managed, whereas in the low risk groups there may be more ambiguity. • Further analyses can help define the appropriate target group for pharmacogenetic testing for variants of drug metabolism. Source of funding: Genelex unrestricted research grant Presented at: ISPOR Annual International Meeting 2015, May 16-20, 2015. Philadelphia, PA, USA Pharmacotherapy Outcomes Research Center
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