Genomic sequencing offers promise, peril

By 2021, genomic sequencing costs could reach $25 billion

TIME magazine last week explored how genetic sequencing could lead to early diagnosis and care for many patients, but also contribute to spiraling U.S. health care costs.

The individual cost of gene sequencing

With a price tag of less than $10,000—and falling—whole-genome sequencing (WGS) is increasingly available to mass-market consumers. Yet few insurers are willing to cover the service because the technology is new and unproven. Insurers also share in the CDC's cautious stance that geneticists still do not understand how to decipher all of our genetic codes.

Still, a 2010 Health Economics study found that 88% of people want to receive tests that predict their risk of contracting certain diseases. Few understand that the results could make it difficult for them to obtain life insurance, disability insurance, or long-term-care insurance. (Although the 2008 Genetic Information Nondiscrimination Act prohibits insurers from genetic discrimination, the law does not apply to other types of insurance.)

How much could it cost our health care system?

A survey by UnitedHealthcare found that more than half of 1,254 physicians think that unlocking the secrets of the genome will increase overall health care spending. In addition, the insurance giant estimates that the U.S. spent more than $5 billion on genetic testing in 2010; by 2021 that figure could reach $25 billion.

And TIME notes that unlocking the secrets of patients' DNA is often the beginning, rather than the end, of their medical care. Jim Evans, professor of genetics and medicine at the University of North Carolina, notes that indiscriminately sequencing the genome could result in myriad false positive results that lead to unnecessary testsunnecessarily bolstering the costs of care.

Moreover, he adds that while "Most diseases have a genetic component...your genomic information provides precious little in the way of tangible guidance for you to live a healthy life. You don't need to sequence someone's genome to tell them they should be exercising and eating right."

What are the benefits?

Analyzing each person's genome also could generate significant cost savings by identifying a patient's risks early and addressing them with preventive measures rather than waiting to treat a patient with a more advanced disease.

Writing in JAMA, Katrina Armstrong of the University of Pennsylvanias Perelman School of Medicine notes that tests of just 21 genes could help identify the type of chemotherapy that would be most effective in treating certain types of breast cancer and, in the process, save the U.S. health care system $400 million each year. "If genomics can help us understand who will get the most benefit and who will get little or no benefit from an intervention, it will take us a long way towards improving patient outcomes and saving money," she says (Rochman, TIME, 10/26).

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