PII-072 - A VALUE PROPOSITION FOR USING PHARMACOGENETIC TESTING IN MENTAL HEALTH CARE

N. Sperber¹, M. Roberts², D. Cragun³, L. Bendz⁴, S. Haga⁵, R. Wu⁶, N. Petry⁷, L. Ramsey⁸, R. Uber⁹; ¹Durham VA Health Care System and Duke University Department of Population Health Sciences, ²UNC Eshelman School of Pharmacy, ³University of South Florida, ⁴Duke Health, ⁵Duke University School of Medicine, ⁶23 and Me, ⁷Sanford Imagenetics, ⁸Children's Mercy, ⁹Geisinger.

Background: While evidence supports use of pharmacogenetics in practice, achieving benefits depends on the extent to which providers value and use it. Currently, widespread adoption lags across and within institutions. We identified a value proposition for using pharmacogenetics to prescribe mental health medications based on providers’ real-world experiences.

Methods: We interviewed prescribers of mental health medications to understand why they decided to use or not use pharmacogenetic tests in their practice using questions rooted in the field of Implementation Science. To identify a value proposition, we organized data according to the Institute for Health Care Improvement Triple Aim, a leading framework for health care policy which asserts that high value care should focus on three key metrics: 1) better health care quality, 2) population level outcomes, and 3) reduced per capita costs.

Results: The sample consisted of 29 providers (16 adopters and 13 non-adopters) from four health care systems with varied levels of institutional support for pharmacogenetic testing. We report findings for each metric: 1) Quality: While providers generally suggested that pharmacogenetic testing does not offer clear advantages over use of trial and error in prescribing, they said that it enhances care through more confidence in and patient buy-in of medication choices; however, certain non-adopters expressed that pharmacogenetic testing would detract from “the art side” of prescribing. 2) Population: Primary care providers said that their use of pharmacogenetic testing could improve their capacity for and in turn patients’ access to mental health medications, especially in rural areas with fewer specialists. 3) Cost: Adopters consistently indicated that they discussed cost with their patients to let them decide, while non-adopters who did not perceive value in pharmacogenetic testing did not have those discussions.

Conclusion: Data suggest a key value proposition for pharmacogenetic testing at the population-level, meeting a need for better access to and treatment of mental health care. However, providers expressed divided views about whether pharmacogenetic testing will improve quality of care. And, while not a clear value proposition, findings show provider willingness to discuss cost with patients may be important in their decision to adopt testing.