When everyone poo poo'd Warfarin, I became very, very upset. Here was a good clinical case for using PGx tests. Not a great case, but a good case. It was only when I began to think about feasability.
Friday, February 5, 2010
Lets face it, most decisions around starting coumadin happen in the hospital. Why?
Well, most patients receive an anticoagulation injection medication that most people have to be specially trained to administer at home versus a nurse in the hospital. Further, the rat poison known as coumadin is dangerous to take and is tricky to dose. So in the hospital is where a lot of people get titrated to the right dose.
This creates multiple problems
1. Insurers do not like paying for expensive meds like low molecular weight Heparin
2. Insurers do not like paying for extra hopsital days to dose a medication
3. Hospitals do not make any more money keeping people in the hospital to dose coumadin
4. Doctors do like to keep patients safe
This creates a market opportunity with demand.
But the question remains "Will testing get patients out of hospital quicker?"
Does this testing keep patients safer?
Will the FDA change the label?
They already did.
However, how many hospitals can run CYP2C9 and VKORC1?
Not very many.
What is the TAT?
Unless it is 24 hours it will not be that helpful.
Now as a Hospital, what is the ROI?
Now as a Insurer what is the ROI?
Now as a physician what is the cost of interpretation?
From a view point of a clinician who supports Personalized Medicine. We need to get rid of Coumadin and use Dabigatriban.
Is this testing useful? Yes. Is it clinically utilizable. If you are willing to wait a month.
Will this get quicker? Yes.
How much quicker? 2 weeks quicker.....but the fact remains, unless you can get a TAT of 12-24 hours this is not a reality in most worlds.....
The Sherpa Says: Great that the FDA notices the utility, but not great that the test is still too slow.
Posted by Steve Murphy MD at 6:46 AM