Many people have hoped that genetic tests will improve medical care and bring down medical costs. Ideally, they could help us 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. Even when advances lead to better health, the improvement doesn’t always translate into cost savings. So far, in fact, the current genetic tests as a group seem to add to medical costs So concluded a 2014 study that pooled results from 59 studies of various personalized medicine tests from the years 1998 through 2011.
In 20 percent of the studies, researchers found that a test or category of tests saved money. But in 72 percent, the tests analyzed led to better health at a price. How much? Usually less than $100,000 for every year of improved health. In the remaining eight percent, researchers saw added costs with no health benefit.
This isn’t the final word, of course. Things may already have shifted. Since the study covered treatment going back to the 1990s, it doesn’t reflect only state-of-the-art care. Also, many tests simply haven’t been evaluated yet, or can’t be — because it’s difficult to say precisely how they affect health.
The dream is that we’d each get a genetic blueprint as a baby that will tell us exactly what health problems to screen for and we’d avoid serious illness through prevention or catch all incipient problems early. However, 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 by the prestigious Cochrane Library.
The cost-effectiveness of screening depends on the illness. Screening for hypertension and colorectal and breast cancer are good investments, according to Steven Woolf, MD, and 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.
Why might that be? Costs soar when you screen entire populations to find a very small number who may be in danger, and the response to any danger signs may be ambiguous and expensive. On the other hand, childhood immunizations and adult immunizations for pneumonia and the flu save money because the vaccines are cheap and many people are vulnerable to those diseases, a 2009 analysis by the Robert Wood Johnson Foundation concluded.
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 in order to monitor conditions that have cropped up in your family. Let’s say you’re obese or have diabetes in the family. Those are two good reasons to make sure your blood sugar levels aren’t creeping up.
You might consider genetic testing if you have a family history of particular illnesses and the test promises results that could affect your medical care and behavior. If you’re not sure, ask.
If you’re ill, tests that fine-tune the predicted results with an expensive or debilitating medicine make sense. A variety of tests are helpful for breast cancer patients. For example, Oncotype DX — which helps patients skip chemo — may save up to $2,000 per patient. Other tests help skin cancer and lung cancer.
However, tests that simply keep terminally ill cancer patients alive longer aren’t likely to be cost-savers. One analysis pooling 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 the cancer was the same.
September 14, 2016
Christopher Nystuen, MD, MBA