The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
S B Haga - One of the best experts on this subject based on the ideXlab platform.
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horizon scan of clinical laboratories offering Pharmacogenetic Testing
Health Affairs, 2018Co-Authors: S B Haga, Ariel KantorAbstract:Pharmacogenetic (PGx) Testing involves the analysis of genes known to affect response to medications. The field has been projected as a leading application of personalized or precision medicine, but the use of PGx tests has been stymied, in part, by the lack of clinical evidence of utility and reported low provider awareness. Another factor is the availability of Testing. The range and types of PGx tests available have not been assessed to date. In the period September 2017–January 2018 we analyzed the numbers and types of PGx tests offered by clinical Testing laboratories in the US. Of the 111 such labs that we identified, we confirmed that 76 offered PGx Testing services. Of these, 31 offered only tests for single genes; 30 offered only tests for multiple genes; and 15 offered both types of tests. Collectively, 45 laboratories offered 114 multigene panel tests covering 295 genes. The majority of these tests did not have any clinical guidelines. PGx tests vary in type and makeup, which presents challenge...
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integrating Pharmacogenetic Testing into primary care
Expert review of precision medicine and drug development, 2017Co-Authors: S B HagaAbstract:Introduction: Pharmacogenetic (PGx) Testing has greatly expanded due to enhanced understanding of the role of genes in drug response and advances in DNA-based Testing technology development. As man...
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primary care providers use of pharmacist support for delivery of Pharmacogenetic Testing
Pharmacogenomics, 2017Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Alex Cho, Geoffrey S. GinsburgAbstract:Aim: To investigate provider utilization of pharmacist support in the delivery of Pharmacogenetic Testing in a primary care setting. Methods: Two primary care clinics within Duke University Health System participated in the study between December 2012 and July 2013. One clinic was provided with an in-house pharmacist and the second clinic had an on-call pharmacist. Results: Providers in the in-house pharmacist arm consulted with the pharmacist for 13 of 15 cases, or about one of every four patients tested compared with one of every 7.5 patients in the on-call pharmacist arm. A total of 63 tests were ordered, 48 by providers in the pharmacist-in-house arm. Conclusion: These findings suggest that the availability of an in-house pharmacist increases the likelihood of Pharmacogenetic test utilization.
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assessing feasibility of delivering Pharmacogenetic Testing in a community pharmacy setting
Pharmacogenomics, 2017Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Deepak VooraAbstract:Aim: To describe the rationale and design of a study evaluating the delivery of Pharmacogenetic (PGx) Testing in community pharmacies. Study rationale: Pharmacists have expressed interest in offering PGx Testing; however, their lack of knowledge and experience, patients’ acceptance and feasibility are unknown in this setting. Study design: Through a cluster randomized trial, we will assess pharmacist and patient experiences with delivery of PGx Testing as a standalone service or integrated into medication therapy management services. Anticipated results: We anticipate that PGx Testing can be delivered in a community pharmacy setting and accepted and valued by patients. Conclusion: This study is expected to provide valuable evidence about the real-world feasibility and acceptance of a community pharmacist-delivered approach of PGx Testing.
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patient experiences with Pharmacogenetic Testing in a primary care setting
Pharmacogenomics, 2016Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Alex Cho, Geoffrey S. GinsburgAbstract:Aim: To investigate patient experiences with Pharmacogenetic (PGx) Testing. Methods: Patients were offered PGx Testing through a study on pharmacist-assisted delivery of PGx Testing and invited to complete pre- and post-Testing surveys about their experience. Results: Of 63 patients tested, 17 completed the baseline survey (27%). Interest in Testing was mostly impacted by desire to inform selection of best treatment (n = 13). Seven of 12 patients that completed the follow-up survey indicated that their provider discussed the test result with them. Five patients understood their test result very or somewhat well. All would be likely to have PGx Testing again. Conclusion: Patients perceived PGx Testing to be useful, though more effort may be needed to improve patient–provider communication of test results.
Jivan Moaddeb - One of the best experts on this subject based on the ideXlab platform.
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primary care providers use of pharmacist support for delivery of Pharmacogenetic Testing
Pharmacogenomics, 2017Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Alex Cho, Geoffrey S. GinsburgAbstract:Aim: To investigate provider utilization of pharmacist support in the delivery of Pharmacogenetic Testing in a primary care setting. Methods: Two primary care clinics within Duke University Health System participated in the study between December 2012 and July 2013. One clinic was provided with an in-house pharmacist and the second clinic had an on-call pharmacist. Results: Providers in the in-house pharmacist arm consulted with the pharmacist for 13 of 15 cases, or about one of every four patients tested compared with one of every 7.5 patients in the on-call pharmacist arm. A total of 63 tests were ordered, 48 by providers in the pharmacist-in-house arm. Conclusion: These findings suggest that the availability of an in-house pharmacist increases the likelihood of Pharmacogenetic test utilization.
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assessing feasibility of delivering Pharmacogenetic Testing in a community pharmacy setting
Pharmacogenomics, 2017Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Deepak VooraAbstract:Aim: To describe the rationale and design of a study evaluating the delivery of Pharmacogenetic (PGx) Testing in community pharmacies. Study rationale: Pharmacists have expressed interest in offering PGx Testing; however, their lack of knowledge and experience, patients’ acceptance and feasibility are unknown in this setting. Study design: Through a cluster randomized trial, we will assess pharmacist and patient experiences with delivery of PGx Testing as a standalone service or integrated into medication therapy management services. Anticipated results: We anticipate that PGx Testing can be delivered in a community pharmacy setting and accepted and valued by patients. Conclusion: This study is expected to provide valuable evidence about the real-world feasibility and acceptance of a community pharmacist-delivered approach of PGx Testing.
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patient experiences with Pharmacogenetic Testing in a primary care setting
Pharmacogenomics, 2016Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Alex Cho, Geoffrey S. GinsburgAbstract:Aim: To investigate patient experiences with Pharmacogenetic (PGx) Testing. Methods: Patients were offered PGx Testing through a study on pharmacist-assisted delivery of PGx Testing and invited to complete pre- and post-Testing surveys about their experience. Results: Of 63 patients tested, 17 completed the baseline survey (27%). Interest in Testing was mostly impacted by desire to inform selection of best treatment (n = 13). Seven of 12 patients that completed the follow-up survey indicated that their provider discussed the test result with them. Five patients understood their test result very or somewhat well. All would be likely to have PGx Testing again. Conclusion: Patients perceived PGx Testing to be useful, though more effort may be needed to improve patient–provider communication of test results.
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incorporation of Pharmacogenetic Testing into medication therapy management
Pharmacogenomics, 2015Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Mahesh J Patel, William E Kraus, Nancy Allen M LapointeAbstract:Aim: To assess feasibility and patient satisfaction with a pharmacist-delivered medication therapy management (MTM) plus Pharmacogenetic (PGx) Testing service. Methods: Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx Testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported medication adherence, patient recall of results and perceived value of Testing and MTM. Results: Overall, patients were very satisfied with the MTM plus PGx Testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx Testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min. Conclusion: PGx Testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.
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community pharmacists experience with Pharmacogenetic Testing
Journal of The American Pharmacists Association, 2015Co-Authors: Jivan Moaddeb, Rachel Mills, S B HagaAbstract:Abstract Objective : To characterize the experiences and feasibility of offering Pharmacogenetic (PGx) Testing in a community pharmacy setting. Design: Pharmacists were invited to complete a survey about PGx Testing for each patient who was offered Testing. If the patient consented, pharmacists were also asked to complete a follow-up survey about the process of returning PGx Testing results to patients and follow-up with the prescribing provider. Setting: Community pharmacies in North Carolina from August through November 2014. Participants: Pharmacists at five community pharmacies. Main outcome measures: Patient consent for Testing, time to introduce PGx Testing initially and communicate results, interpretation of test results, and recommended medication changes. Results : Of the 69 patients offered Testing, 56 (81%) consented. Pre-test counseling typically lasted 1–5 minutes (81%), and most patients (55%) did not have any questions about the Testing. Most pharmacists reported test results to patients by phone (84%), with discussions taking less than 1minute (48%) or 1–5 minutes (52%). Most pharmacists believed the patients understood their results either very well (54%) or somewhat well (41%). Pharmacists correctly interpreted 47 of the 53 test results (89%). All of the incorrect interpretations were for patients with test results indicating a dosing or drug change (6/19; 32%). Pharmacists reported contacting the ordering physician for four patients to discuss results indicating a dosage or drug change. Conclusion : The provision of PGx services in a community pharmacy setting appears feasible, requiring little additional time from the pharmacist, and many patients seem interested in PGx Testing. Additional training may be necessary to improve test result interpretation, as well as for communication with both patients and ordering physicians.
Gesche Jurgens - One of the best experts on this subject based on the ideXlab platform.
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does Pharmacogenetic Testing for cyp450 2d6 and 2c19 among patients with diagnoses within the schizophrenic spectrum reduce treatment costs
Basic & Clinical Pharmacology & Toxicology, 2013Co-Authors: Louise Herbild, Stig Andersen, Thomas Werge, Henrik B Rasmussen, Gesche JurgensAbstract:The effect of Pharmacogenetic Testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without Pharmacogenetic Testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treatment based on Pharmacogenetic Testing and 103 patients to treatment as usual. Random exclusion of extensive and intermediate metabolizers was used to increase the frequency of extreme metabolizers (poor metabolizers and ultrarapid metabolizers for CYP2D6) to 20% in both groups. Cost differences were analysed at several levels including (i) overall healthcare expenditure, (ii) psychiatric hospital cost (iii) nonpsychiatric hospital cost, (iv) primary care spending and (v) pharmaceuticals. Statistically significant differences in costs of psychiatric care dependent on metabolizer status were found between intervention groups. Pharmacogenetic Testing significantly reduced costs among the extreme metabolizers (poor metabolizers and ultrarapid metabolizers) to 28%. Use of primary care services and pharmaceuticals was also affected by the intervention.This study confirms earlier findings that extreme metabolizers (poor and ultrarapid metabolizers) incur higher costs than similar patients with a normal metabolizer genotype. However, this study shows that these excess costs can be reduced by Pharmacogenetic Testing. Pharmacogenetic Testing for CYP2D6 and CYP2C19 could thus be considered as a means of curtailing high psychiatric treatment costs among extreme metabolizers.
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does Pharmacogenetic Testing for cyp450 2d6 and 2c19 among patients with diagnoses within the schizophrenic spectrum reduce treatment costs
Basic & Clinical Pharmacology & Toxicology, 2013Co-Authors: Louise Herbild, Stig Andersen, Thomas Werge, Henrik B Rasmussen, Gesche JurgensAbstract:The effect of Pharmacogenetic Testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without Pharmacogenetic Testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treat- ment based on Pharmacogenetic Testing and 103 patients to treatment as usual. Random exclusion of extensive and intermediate metabolizers was used to increase the frequency of extreme metabolizers (poor metabolizers and ultrarapid metabolizers for CYP2D6) to 20% in both groups. Cost differences were analysed at several levels including (i) overall healthcare expenditure, (ii) psychiatric hospital cost (iii) nonpsychiatric hospital cost, (iv) primary care spending and (v) pharmaceuticals. Statistically significant differences in costs of psychiatric care dependent on metabolizer status were found between intervention groups. Phar- macogenetic Testing significantly reduced costs among the extreme metabolizers (poor metabolizers and ultrarapid metabolizers) to 28%. Use of primary care services and pharmaceuticals was also affected by the intervention.This study confirms earlier find- ings that extreme metabolizers (poor and ultrarapid metabolizers) incur higher costs than similar patients with a normal metaboli- zer genotype. However, this study shows that these excess costs can be reduced by Pharmacogenetic Testing. Pharmacogenetic Testing for CYP2D6 and CYP2C19 could thus be considered as a means of curtailing high psychiatric treatment costs among extreme metabolizers. Limited healthcare budgets and cost-containment challenge payers and providers of health care worldwide. New technolo- gies and treatments are compared with existing ones to maxi- mize health gain. Pharmacogenetic Testing (PGx) is one among these new technologies. In psychiatry, several attempts have been made to estimate whether PGx for polymorphisms (genetic changes) in different genes provides a cost-effective alternative to treatment based on clinical dose titration or ther- apeutic (1-5). Psychiatric treatment is characterized by problems of adverse drug reactions and lack of effect. This leads to com- pliance problems, frequent shifts in medicine and high costs (6-8). PGx was expected to ease some of these problems. The fundamental hypothesis being that knowledge regarding patients' genotype could guide the treating clinician in the choice of pharmaceutical and/or dosage. This could potentially individualize treatment and reduce the time from initiation of pharmaceutical therapy until an acceptable medical response occurs, thus leading to improved patient treatment, care and
Louise Herbild - One of the best experts on this subject based on the ideXlab platform.
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does Pharmacogenetic Testing for cyp450 2d6 and 2c19 among patients with diagnoses within the schizophrenic spectrum reduce treatment costs
Basic & Clinical Pharmacology & Toxicology, 2013Co-Authors: Louise Herbild, Stig Andersen, Thomas Werge, Henrik B Rasmussen, Gesche JurgensAbstract:The effect of Pharmacogenetic Testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without Pharmacogenetic Testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treatment based on Pharmacogenetic Testing and 103 patients to treatment as usual. Random exclusion of extensive and intermediate metabolizers was used to increase the frequency of extreme metabolizers (poor metabolizers and ultrarapid metabolizers for CYP2D6) to 20% in both groups. Cost differences were analysed at several levels including (i) overall healthcare expenditure, (ii) psychiatric hospital cost (iii) nonpsychiatric hospital cost, (iv) primary care spending and (v) pharmaceuticals. Statistically significant differences in costs of psychiatric care dependent on metabolizer status were found between intervention groups. Pharmacogenetic Testing significantly reduced costs among the extreme metabolizers (poor metabolizers and ultrarapid metabolizers) to 28%. Use of primary care services and pharmaceuticals was also affected by the intervention.This study confirms earlier findings that extreme metabolizers (poor and ultrarapid metabolizers) incur higher costs than similar patients with a normal metabolizer genotype. However, this study shows that these excess costs can be reduced by Pharmacogenetic Testing. Pharmacogenetic Testing for CYP2D6 and CYP2C19 could thus be considered as a means of curtailing high psychiatric treatment costs among extreme metabolizers.
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does Pharmacogenetic Testing for cyp450 2d6 and 2c19 among patients with diagnoses within the schizophrenic spectrum reduce treatment costs
Basic & Clinical Pharmacology & Toxicology, 2013Co-Authors: Louise Herbild, Stig Andersen, Thomas Werge, Henrik B Rasmussen, Gesche JurgensAbstract:The effect of Pharmacogenetic Testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without Pharmacogenetic Testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treat- ment based on Pharmacogenetic Testing and 103 patients to treatment as usual. Random exclusion of extensive and intermediate metabolizers was used to increase the frequency of extreme metabolizers (poor metabolizers and ultrarapid metabolizers for CYP2D6) to 20% in both groups. Cost differences were analysed at several levels including (i) overall healthcare expenditure, (ii) psychiatric hospital cost (iii) nonpsychiatric hospital cost, (iv) primary care spending and (v) pharmaceuticals. Statistically significant differences in costs of psychiatric care dependent on metabolizer status were found between intervention groups. Phar- macogenetic Testing significantly reduced costs among the extreme metabolizers (poor metabolizers and ultrarapid metabolizers) to 28%. Use of primary care services and pharmaceuticals was also affected by the intervention.This study confirms earlier find- ings that extreme metabolizers (poor and ultrarapid metabolizers) incur higher costs than similar patients with a normal metaboli- zer genotype. However, this study shows that these excess costs can be reduced by Pharmacogenetic Testing. Pharmacogenetic Testing for CYP2D6 and CYP2C19 could thus be considered as a means of curtailing high psychiatric treatment costs among extreme metabolizers. Limited healthcare budgets and cost-containment challenge payers and providers of health care worldwide. New technolo- gies and treatments are compared with existing ones to maxi- mize health gain. Pharmacogenetic Testing (PGx) is one among these new technologies. In psychiatry, several attempts have been made to estimate whether PGx for polymorphisms (genetic changes) in different genes provides a cost-effective alternative to treatment based on clinical dose titration or ther- apeutic (1-5). Psychiatric treatment is characterized by problems of adverse drug reactions and lack of effect. This leads to com- pliance problems, frequent shifts in medicine and high costs (6-8). PGx was expected to ease some of these problems. The fundamental hypothesis being that knowledge regarding patients' genotype could guide the treating clinician in the choice of pharmaceutical and/or dosage. This could potentially individualize treatment and reduce the time from initiation of pharmaceutical therapy until an acceptable medical response occurs, thus leading to improved patient treatment, care and
Jason L. Vassy - One of the best experts on this subject based on the ideXlab platform.
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Pharmacogenetic Testing in the veterans health administration vha policy recommendations from the vha clinical Pharmacogenetics subcommittee
Genetics in Medicine, 2019Co-Authors: Victoria M Pratt, Jason L. Vassy, Annjanette Stone, John T Callaghan, Margaret A S Mendes, Laurence Meyer, Ronald M Przygodzki, Maren T ScheunerAbstract:The Veterans Health Administration (VHA) Clinical Pharmacogenetics Subcommittee is charged with making recommendations about whether specific Pharmacogenetic tests should be used in healthcare at VHA facilities. We describe a process to inform VHA Pharmacogenetic Testing policy. After developing consensus definitions of clinical validity and utility, the Subcommittee identified salient drug–gene pairs with potential clinical application in VHA. Members met monthly to discuss each drug–gene pair, the evidence of clinical utility for the associated Pharmacogenetic test, and any VHA-specific Testing considerations. The Subcommittee classified each test as strongly recommended, recommended, or not routinely recommended before drug initiation. Of 30 drug–gene pair tests reviewed, the Subcommittee classified 4 (13%) as strongly recommended, including HLA-B*15:02 for carbamazepine-associated Stevens–Johnston syndrome and G6PD for rasburicase-associated hemolytic anemia; 12 (40%) as recommended, including CYP2D6 for codeine toxicity; and 14 (47%) as not routinely recommended, such as CYP2C19 for clopidogrel dosing. Only half of drug–gene pairs with high clinical validity received Subcommittee support for policy promoting their widespread use across VHA. The Subcommittee generally found insufficient evidence of clinical utility or available, effective alternative strategies for the remainders. Continual evidence review and rigorous outcomes research will help promote the translation of Pharmacogenetic discovery to healthcare.
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Impact of SLCO1B1 Pharmacogenetic Testing on Patient and Healthcare Outcomes: A Systematic Review.
Clinical pharmacology and therapeutics, 2018Co-Authors: Jason L. Vassy, Sojeong Chun, Sanjay Advani, Sophie A. Ludin, Jason G. Smith, Elaine C. AlligoodAbstract:Demonstrated improvements in patient outcomes will facilitate the clinical implementation of Pharmacogenetic Testing. Using the association between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and statin-associated muscle symptoms (SAMSs) as a model, we conducted a systematic review of patient outcomes after delivery of SLCO1B1 results. Using PubMed and Embase searches through December 19, 2017, we identified 37 eligible records reporting preliminary or final outcomes, including six studies delivering only SLCO1B1 results and five large healthcare system-based implementation projects of multipharmacogene panels. Two small trials have demonstrated at least short-term improvements in low-density lipoprotein cholesterol after SLCO1B1 Testing among previously statin intolerant patients. Evidence from large implementation projects suggests that SLCO1B1 results may change prescribing patterns for some high-risk patients. No study has reported improvements in SAMSs or cardiovascular events or tracked the economic outcomes of SLCO1B1 Testing. Ongoing studies should collect and report outcomes relevant to Pharmacogenetics stakeholders.