The cost of sequencing has been rapidly dropping ever since the first complete human genome was sequenced over a decade ago. Conventional wisdom says that should lead to an overall drop in medical spending. A popular argument claims that for genomic testing, this may not necessarily be the case. Genetic tests currently on the market are mainly applied in very narrow circumstances. The industry does not yet have a comprehensive, point-of-care tool that makes implementation of genetic testing easy and efficient. Once these factors are addressed, genomic testing will lead to a wider berth of these types of tests. Even with the drop in cost, the additional percentage of the population might wipe out any overall cost savings.
One example of a lower cost for a procedure leading to an overall increase in medical spending is in a gallbladder procedure. In the early 1990’s, laparoscopic cholecystectomy replaced a straight cholecystectomy as the standard procedure to remove the gallbladder. The latter is an invasive procedure that often requires a few days in the hospital to recover, while the new procedure only involves minor incisions, and no in-hospital recovery. Laparoscopic cholecystectomy is cheaper to perform, and poses much less risk. As a result, the amount of patients to have their gallbladder removed increased dramatically. Despite the new procedure being significantly cheaper, the amount of new patients now able to receive the procedure erased any overall savings on total medical expenditures. On the other hand, 20% more patients with gallbladder issues got an effective treatment. Clinical genomics is a radically different process that will not follow the same path.
Genomics has potential effectiveness in a broad range of clinical applications. Instead of treating one specific disease or condition, genomics can be used in a wide variety of ways. Genome tests are particularly useful in determining treatment for many cancers and varieties of heart conditions, as well as reaching a diagnosis for unknown diseases. In addition, genomics can also be used to predict medication interactions and screen for risk. In many ways genomic testing can serve as a jumping off point, revealing information that aids in building treatments and confirming diagnoses, which may lead to a slew of different tests, or reveal a path to treatment. The revealed treatment may be expensive, like in the case of orphan drugs, but it’s just as likely that the treatment revealed will lead to a cost-savings. A patient revealed to be at high risk for heart-attack may be prescribed an inexpensive blood thinner, preventing not only a cardiac event but the associated steep costs. If used correctly, genome testing can actually save money. All of these factors combine to make genomic testing an effective tool for a wide patient population.
The argument that if a procedure leads to an overall increase in medical spending, then it should be considered a failure is short-sighted. What first needs to be considered is if the new procedure is effective, then the cost. Often times, a new effective treatment is too expensive to be implemented. This isn’t the case with genome testing, which is both clinically effective and an inexpensive test. These two elements combined will lead to more patients getting tested. Genome testing is unlike other medical procedures, it stands to revolutionize the way patients receive care by making the focus truly personalized. If used correctly, genome testing will actually save the industry money. Healthcare professionals are excited that the cost of sequencing the entire exome has become affordable. New Amsterdam Genomics wants as many patients as possible to get sequenced, because it will lead to greater clinical outcomes. An overall increase in medical spending is a possibility, but doesn’t matter in the face of a higher quality of care.