Personalized Medicine

With the advent of DNA sequencing, the possibility of understanding how individual variation in genetic coding and expression might contribute to health and disease became apparent.  Although the cost of sequencing has fallen substantially, turning genetic information into something of clinical utility, especially for the mass of scientists and patients, is proving to be more difficult than originally anticipated.  Partly this is due to the complexity of human gene expression and biochemistry and partly to a lack of rigorous trials to more clearly identify cause and effect.  Nonetheless, increasingly there are tests available to develop and report genetic data for use in daily medical practice.  A new report from UnitedHealth Group discusses trends in this area of personalized medicine.   (UHG Report)    One of the most interesting aspects of the report is the revelation by UHG of its own spending on genetic testing, which was about $500 million in 2010.  Of this, 40% was for infectious diseases, 16% for cancer and the remainder for things like inherited disorders.  Spending was higher in the Medicaid and Medicare populations.

Spending increased about 14% a year between 2008 and 2010.  UHG believes national spending on this category was about $5 billion in 2010, about 8% of all clinical laboratory spending.  The company projects that $15-25 billion will be spent on genetic testing by 2021.  A significant majority of both physicians and patients have positive attitudes toward genetic testing.  The company makes a number of recommendations regarding effective and cost-efficient use of the tests.  One of the clear concerns in the report is the ultimate cost effect of this new class of technology.  Genetic testing and genetically-based treatments are expensive and in an era where controlling cost is paramount there is natural apprehension about what the net effect of use of these capabilities will be.  Unfortunately too much of our new medical technology does not have an overall reducing effect on spending.  It often is not curative, but instead prolongs life, often providing a better quality of life, and just substitutes for less expensive prior forms of care.  If genetic testing and treatment really could cure diseases, they might have a net long-run effect of reducing spending, but so far the evidence suggests that they are merely additive.