Presentation Title (IN ALL CAPS)

UTILITY OF PHARMACOGENOMICS IN CHILDREN WITH CHRONIC DISEASE

Departmental Affiliation and City, State, Zip for All Authors

Department of Microbiology Immunology and Genetics, Graduate School of Biomedical Sciences, UNTHSC 3500 Camp Bowie Blvd. Fort Worth, TX 76107; Deaprtment of Pediatrics, Texas College of Osteopathic Medicine, , UNTHSC 3500 Camp Bowie Blvd. Fort Worth, Tx 76107; Department of Family Medicine, Texas College of Osteopathic Medicine, UNT Health Science Center, UNTHSC 3500 Camp Bowie Blvd. Fort Worth, Tx 76107;

Classification

UNTHSC Faculty

Research Presentation Category

Health Disparities

Layperson Narrative or Summary (3-5 sentences)

Because children with chronic disease are likely to take a number of different drugs during their lifetime, they are at higher risk of having a serious drug reaction. We want to know if using DNA to help prescribe drugs would be a cost effective way of reducing drug reactions in this population.

Scientific Abstract

Problem Statement: We hypothesize that using pharmacogenomic prescribing in children with chronic conditions will reduce adverse drug reactions. Background: In other populations, pharmacogenomic prescribing has been effective. In an elderly population, hospitalization, emergency room visits, and outpatient visits decreased when pharmacogenomic testing was implemented. Materials and Methods: We developed a Markov model for comparing the utility of a pharmacogenomic intervention in children. For every year of life a population undergoes four potential states, 1) Classification of health; 2) classification of ADR ; 3) Classification of life state; 4) Classification of ADR seriousness. The model is then repeated for 20 cycles. Results to date: Initial parameters were, 1) X% percent of individuals with chronic disease, 2) X% of individuals with an ADR; 3) X% mortality rate; 4) 20% of individuals with an ADR were serious. Genotyping reduced ADRs by 30%, genotyping cost $200, an ADR cost was $2000 and a serious ADR $10,000. Pharmacogenomic testing was cost effective with cost per quality adjusted life year (QALY) of $26,250. Genotyping remained cost effective <$60,000 per QALY for any scenario that reduced ADRs by >=15% serious ADR>= 20% of all ADRs and if an ADR resulted in a >= 30% or greater reduction in quality of life. Future research: We will determine clinical utility in different racial and ethnic backgrounds based on differences in allele frequencies, prescribed drugs, and healthcare utilization. We will also determine whether ADRs and the anxiety they cause lead to different reductions in QALYs based on different cultural and societal experiences of the individual.

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UTILITY OF PHARMACOGENOMICS IN CHILDREN WITH CHRONIC DISEASE

Problem Statement: We hypothesize that using pharmacogenomic prescribing in children with chronic conditions will reduce adverse drug reactions. Background: In other populations, pharmacogenomic prescribing has been effective. In an elderly population, hospitalization, emergency room visits, and outpatient visits decreased when pharmacogenomic testing was implemented. Materials and Methods: We developed a Markov model for comparing the utility of a pharmacogenomic intervention in children. For every year of life a population undergoes four potential states, 1) Classification of health; 2) classification of ADR ; 3) Classification of life state; 4) Classification of ADR seriousness. The model is then repeated for 20 cycles. Results to date: Initial parameters were, 1) X% percent of individuals with chronic disease, 2) X% of individuals with an ADR; 3) X% mortality rate; 4) 20% of individuals with an ADR were serious. Genotyping reduced ADRs by 30%, genotyping cost $200, an ADR cost was $2000 and a serious ADR $10,000. Pharmacogenomic testing was cost effective with cost per quality adjusted life year (QALY) of $26,250. Genotyping remained cost effective <$60,000 per QALY for any scenario that reduced ADRs by >=15% serious ADR>= 20% of all ADRs and if an ADR resulted in a >= 30% or greater reduction in quality of life. Future research: We will determine clinical utility in different racial and ethnic backgrounds based on differences in allele frequencies, prescribed drugs, and healthcare utilization. We will also determine whether ADRs and the anxiety they cause lead to different reductions in QALYs based on different cultural and societal experiences of the individual.