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An Innovation Revolution — How Genetic Testing is Improving Health and the Economy. Kenneth Sisco, MD, PhD, FCAP Medical Director Quest Diagnostics . March 17, 2011. Medicine of the past: “Trial-and-Error” medicine. Observe. Diagnose. Treat. Monitor response. Adjust.
How Genetic Testing is Improving Health and the Economy
Kenneth Sisco, MD, PhD, FCAP
March 17, 2011
One-year survival rate for certain cancers
Delays in care
Inappropriate or unnecessary utilization
100,000 new cases early-stage breast cancer
(estrogen-Receptor positive; node negative)
Standard practice in 90% = chemo (after surgery/radiation)
70% receive no benefit from chemo
Source: M Aspinall presentation, 2008;Harvard Business Review 2007; Mayo Clinic; NIH
Trial and Error Medicine
Genetic tests identify DNA of childhood leukemia, enabling physicians to choose the treatment that fits it precisely.
The impact of genetic tests and genome-based cancer drugs on survival of childhood leukemia
Source: New England Journal of Medicine, 2006, 200l; Personalized Medicine Coalition, 2006.
The effect of lab tests combined with anti-HIV drugs
Source: Journal of American Medical Association, 2006; New England Journal of Medicine, 1998; Centers for Disease Control and Prevention
Lifetime risk of developing breast cancer…
…with BRCA 1 and 2 = 36% - 85%
…without = 13%
Lifetime risk of developing ovarian cancer…
…with BRCA 1 and 2 = 16% - 60%
…without = 1.7%
Source: National Cancer Institute
Rx = $300 Billion Annually
Non therapeutic responders =
$60B - $225 Billion annually
Potential savings via better targeting:
Up to $110 Billion
Source: M Aspinall, Harvard Business Review, 10/2007; Spear,Trends in Molecular Medicine, 5/2001; IMS, 2010
Percentage of patients for which standard drug treatment provides effective therapy is shown in blue.
Source: Aspinall, Harvard Business Review, October, 2007; Spear,Trends in Molecular Medicine, May 2001
Genetic tests for dosing of warfarin cut hospitalization
Genetic test leads to drop in hospitalization
Source: Journal of the American College of Cardiology, June, 2010; Brookings/AEI, 2006
Cost of Herceptin per Patient
Without HER2 Test
With HER2 Test
Source: M. Aspinall, Presentation, 3/28/08; J Clin Oncol (2004) ; NEJM (2005)
Cost of drug per patient: $71,120
Cost of test per patient: $452
Source: Shankaran, V, et al, ”Economic Implications of KRAS testing in metastatic colorectal cancer,” Paper presentation, ASCO, 2009; Manci, Am J Health-Syst Pharm., 2009