Modeling Cost Savings Following Use of Pharmacogenetic Testing in a Regional Accountable Care Organization

Abstract: Pharmacogenetic testing (PGx) has been shown to decrease healthcare resource utilization in a variety of settings, including behavioral health1. We have developed a method to receive population level patient drug data, analyze potential drug-drug-interactions (DDI), impute gene-drug-drug interactions (GDDI), and stratify individuals for PGx testing candidacy. To model potential savings for a regional Accountable Care Organization (ACO), we applied the findings of an earlier propensity-matched case-control resource utilization study to the ACO’s population2. A sample of 1825 individuals who had both medical and pharmaceutical claims in Q1 of 2021 was evaluated. In addition to the full population, subpopulations included polypharmacy patients (≥5 meds) and patients who were prescribed at least one behavioral health medication. Patients were rank ordered according to risk of a major or moderate GDDI; those in the ≥ 80th percentile of risk constituted an additional subpopulation. We evaluated inpatient, emergency department and outpatient resource utilization in these populations in the baseline period, and imputed savings to them expected from PGx testing. The greatest expected savings following PGx testing was $3,224 over a 3-month period, which came from polypharmacy patients who were also taking at least one psychotropic. Savings are expected to accrue primarily from decreased emergency room visits and in-patient stays. The projected return on investment (ROI) for this ACO based on the patients in this cohort is 3.6-fold the investment.Short Description: This analysis represents a model of cost savings to an accountable care organization when a population health program and pharmacogenetic testing is applied. The cohort was analyzed as a whole and then subdivided based on presence of polypharmacy or gene-drug-drug interaction risk ≥80%. Cost savings of $2,782 are expected over a 3-month period for polypharmacy patients. When isolating polypharmacy patients with an imputed behavioral health diagnosis, savings are estimated to be $3,224 over 3 months.Name of Sponsoring Organization(s): Genomind