DNA Sequencing As Preventative Care Is Ready For The Clinic

Discussion in 'Serious Discussion' started by parrish, May 14, 2018.

  1. parrish

    parrish MDL Novice

    Oct 16, 2016
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    DNA Sequencing As Preventative Care Is Ready For The Clinic

    Geisinger doctors will soon start offering patients DNA sequencing as part of routine preventative care, the Danville, Pennsylvania-based health system's president and CEO Dr. David Feinberg announced Sunday at the HLTH Conference in Las Vegas.

    “We’re going to start doing it the same way we would talk to patients about getting a cholesterol check,” Feinberg said on a call with reporters Monday morning.

    The new program is separate from Geisinger's research partnership with Regeneron to sequence the DNA of patients enrolled in its MyCode study, which is continuing.

    That study has sequenced the DNA of thousands of patients so far, and about 3.5% have had findings doctors could do something about, Feinberg said. He thinks that number will go up.

    “We didn’t want to wait," Feinberg said.

    "We thought too many lives would be lost if we waited until it was really wrapped in a neat bow in a research capacity.”

    The 1,000-patient clinical pilot program will launch within the next six months at a couple clinics, then scale throughout the system.

    Feinberg says they believe sequencing the exomes, the parts of the genome that give instructions for making proteins, at cost of $300-$500 per patient will be cost effective by catching disease earlier or eliminating disease altogether.

    He gave the example of familial hypercholesterolemia, a genetic condition that causes high cholesterol and an increased risk for cardiovascular disease, heart attack and stroke.

    One in 250 people have the condition, and guidelines say should it be treated starting at age 8, Feinberg says, but “nobody knows who has it because nobody is testing broadly besides us.”

    Patients won’t pay for sequencing, even if they’re not on Geisinger insurance.

    The health system will foot the bill for sequencing with donor funding and funds from its insurance business as a quality initiative to see if the testing really is cost-effective.

    Any additional care the patient gets connected to test results will still be billed.

    Geisinger doesn’t have an exact amount set aside to pay for the tests, but Feinberg estimates it will cost less than $5 million to get a large number of patients sequenced.

    "We think by scaling it we’ll hopefully more quickly show the cost-effectiveness of it, and it will become pretty obvious that everybody should be getting this,” Feinberg said.

    The current MyCode research program is testing 59 different genes for 27 conditions, and it’s still under discussion whether the clinical pilot will do the same or just look for BRCA mutations, Lynch syndrome (which indicates a higher risk for colon cancer) and familial hypercholesterolemia, Geisinger's chief scientific officer David Ledbetter said on the call with reporters.

    The deidentified data will be used for Geisinger’s internal research like all the clinical data it collects, Ledbetter said.

    There's no commercial research partner at this point. Where the sequencing will be done is still being worked out.

    Feinberg compared doing the genetic testing to blood sugar testing for diabetes as an improvement over doctors tasting patients’ urine to see if it was sweet.

    “Nobody asks is that cost-effective. … I think we’re moving from testing urine by tasting it.”


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  2. PointZero

    PointZero MDL Member

    Oct 5, 2011
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    :eek: :icon8: :confused: After reading that, I am glad I'm not a doctor :D
     
  3. Joe C

    Joe C MDL Guru

    Jan 12, 2012
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    No doubt this could affect your health insurance rates if they know your prone to costly services in the future
     
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  4. gorski

    gorski MDL Guru

    Oct 21, 2009
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    Of course but that can be legislated against...

    The biggest point, however, is personalised medicine, which is coming, at least for some.... unless we do something about it, collectively... for the many, as well, not just the few....
     
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