Will Personalized Medicine Save Money?

So far, the evidence of personalized medicine being cost-effective is mixed. But that could change if genetic testing becomes less expensive and more common.   

Many people have hoped that tests for specific genes will improve medical care and lower medical costs. Ideally, they could help people avoid unnecessary treatments, treatments unlikely to work, or other kinds of expensive tests.

We could catch problems earlier and avoid some health issues altogether. 

But medicine is complex. An overview of research did find that medicine based on gene testing (or genome testing, which looks at the patient’s entire DNA) was cost-effective, compared to usual care, in most of the studies.

On the plus side, the cost of genetic lab work has fallen and is expected to decline more, which could make a big difference. That said, a study of one common test, for a rare genetic quirk that can promote blood clots, concluded that it cost taxpayers millions a year and didn’t benefit patients.

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Meanwhile, a tool developed at Memorial Sloan Kettering Cancer Center in New York calculated that only a handful of new anticancer drugs approved over more than a decade were worth the cost.

Sometimes tests benefit patients, but at a price, according to one study.

Tests for preventive medicine

The goal of personalized medicine is for everyone to have a blueprint of their DNA — their genome. Healthcare providers could screen a baby for specific health problems and prevent serious illnesses or catch them early.

Yet preventive medicine isn’t a panacea or necessarily a cost-saver. Even the most basic kind of screening — annual physicals — doesn’t seem to lower the risk of serious illness or prevent premature death, according to a meta-analysis. 

The cost-effectiveness of screening depends on the illness. Screening for hypertension and colon and breast cancer are good investments, according to Steven Woolf, MD, professor of family medicine at Virginia Commonwealth University Medical Center in Richmond.

But general screening for ovarian cancer and testicular cancer, and for prostate cancer via PSA tests, don’t benefit patients, the U.S. Preventive Services Task Force concluded. 

Costs soar when entire populations are screened to find a very small number of people who may be in danger. The response to any danger signs may be ambiguous and expensive, as well.

On the other hand, childhood and adult immunizations for common illnesses like the flu save money because the vaccines are cheap, and many people are vulnerable.

What you can do

As a patient, you may want a test even if it’s not a good idea for everyone to get it. Your doctor may ask to see you for an annual exam to monitor conditions that run in your family.

Let’s say you carry extra weight, and your doctor says you have obesity. Maybe you have a family history of type 2 diabetes. Those are two good reasons to make sure your blood sugar levels aren’t creeping up. 

You might consider testing if you have a family history of an illness, and the test promises results that could affect your medical care and behavior. If you’re not sure, ask your doctor. 

If you’re ill, tests that fine-tune the predicted results of an expensive or debilitating medicine make sense.

A variety of tests are helpful for breast cancer patients. For example, two kinds of Oncotype DX tests — one that  helps patients skip chemotherapy and the other for decisions about radiation — may save money and suffering.  

Other tests help skin cancer and lung cancer patients. But tests that simply keep terminally ill cancer patients alive longer aren’t likely to be cost-savers.

One analysis pooling the results of many studies concluded that, for cancer patients, personalized therapy extended median survival — meaning half died sooner and half lived longer — to more than 19 months, compared to 13.5 months for patients who received other kinds of care.

The number of people who died from their cancer was the same.     

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