September 7, 2016
Anesthesia Business Consultants (ABC), a leading provider in billing and practice management for the anesthesia and pain management specialty, announces its commitment to integrating pharmacogenomics into anesthesia as an approach to increase safety in anesthesiology.
A personalized approach to anesthesia care based on a patient’s genetic composition can allow anesthesiologists to lower the risk of adverse drug reactions (ADRs) and hospital readmissions, according to ABC. Known as pharmacogenomics, the highly tailored approach holds potential to enable anesthesiologists to deliver safer, more cost-effective care.
The approach reflects President Obama’s Precision Medicine Initiative, and is a cornerstone of medical science’s movement toward personalized medicine. It uses genetic data to guide drug development and testing and help physicians select the proper medication or therapy at the proper dose or regimen. Pharmacogenetic testing can help identify patients who are at greater risk of side effects, or are more likely to experience severe side effects at relatively low doses, require a higher dose to achieve a therapeutic effect or receive no benefit from the medication (The Lancet, 2000).
Pharmacogenetic testing is now available to help anesthesiologists risk-stratify patients and tailor treatment. A growing number of laboratories are helping anesthesiologists personalize care using pharmacogenetic testing as a tool to predict a patient’s response to postoperative opioid therapy, treatment for postoperative nausea and vomiting with various anti-emetics, and perioperative risk of thrombosis. These predictions can help anesthesiologists choose the appropriate medications for patients whose genetic profiles indicate that they are likely to react poorly to certain drugs, such as opioids, or to metabolize them too quickly.
A preoperative behavioral and medical risk assessment conducted by a nurse, followed by pharmacogenetic testing in patients identified as being at risk of developing opioid dependence or having opioid-related complications, can alert anesthesiologists to the need to alter treatment. Patients can also keep this valuable information about their genetic composition and share it with other physicians who treat them.
The use of pharmacogenomic testing is not yet widespread, but its future looks bright. According to the National Human Genome Research Institute, “Doctors are starting to use pharmacogenetic information to prescribe drugs, but such tests are routine for only a few health problems. However, given the field’s rapid growth, pharmacogenomics is soon expected to lead to better ways of using drugs to manage heart disease, cancer, asthma, depression and many other common diseases.”
That is already happening. Approximately 100 Food and Drug Administration (FDA)-approved medications now carry such pharmacogenetic testing recommendations on package inserts.
Anesthesiologists might one day use predictive pharmacogenomics to tackle ADRs, which are a serious public health problem. ADRs are the fourth leading cause of death—ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths. They account for an estimated one third of hospital adverse events and approximately 280,000 hospital admissions annually, the Health and Human Services Office of Disease Prevention and Health Promotion reports in its National Action Plan for Adverse Drug Event Prevention.1
Opioids are one of three groups of drugs targeted in the Action Plan because they are one of the most common causes of ADRs and the cause of more than 75 percent of pharmaceutical overdose deaths.
Tony Mira, President and CEO of ABC elaborates, “The ability of anesthesiologists as perioperative physicians to identify patients at risk of opioid addiction preoperatively through risk stratification and pharmacogenetic testing could help mitigate a problem that has reached epidemic scale.” Despite signs of promise, questions need to be answered before pharmacogenetic testing becomes mainstream in medicine. Reimbursement presents an ongoing challenge. Last year, Medicare discontinued payment for some pharmacogenetic testing.
Still, pharmacogenomics is unlikely to disappear. In the not too distant future, clinical application software including anesthesia information systems is expected to incorporate more pharmacogenomic data and decision support.
