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Genetic Testing Users, Costs Expected to Increase

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A working paper released today by UnitedHealthcare, a health care insurance and services company in Minneapolis, says few patients currently use genetic testing, but a large majority of physicians believes their patients could benefit from these tests. The report also estimates some $5 billion is now spent annually on genetic testing, with those costs expected to increase to as much as $25 billion in 2021.

The paper, prepared by UnitedHealthcare’s Center for Health Reform and Modernization, is based on surveys by the polling company Harris Interactive in January-February 2012 of 1,254 primary care and specialist physicians, and 1,506 adult U.S. health care consumers. For analysis purposes, the sample of physicians includes 250 specialists who may be more likely to use genetic testing in their practice: hematologists, oncologists, rheumatologists, and neurologists. The researchers also analyzed UnitedHealthcare insurance claims data from 2008 to 2010 for molecular diagnostic codes, grouped into three categories: infectious disease, cancer, and other genetic tests, including inherited and certain acquired conditions.

Genetic testing, according to the study, analyzes an individual’s or organism’s genetic material, including some 23,000 protein-coding genes and biomarkers. The tests often use molecular diagnostic techniques and are available for an estimated 2,500 conditions, covering both rare and common disorders. Recent estimates suggest that some 1,000 to 1,300 genetic tests are currently available. The tests can uncover a person’s predisposition for a particular disease, detect if a person has a disease at earlier stages than was previously possible, and identify the effectiveness of a particular drug therapy for an individual.

The physicians’ survey indicates that doctors today infrequently call for genetic tests. Physician respondents recommended genetic tests for only about four percent of their patients in the past year, but they anticipate the use of the tests to increase somewhat. The physicians expect that in five years, the number of patients getting genetic tests will increase to 14 percent.

Physicians, according to the survey, have generally favorable opinions of genetic testing. More than six in 10 physician respondents (63%) say the tests give them the ability to diagnose conditions that would otherwise be unknown. And three quarters of the doctors (74%) say there are patients in their practices who have not yet had a genetic test but who would benefit from having one. About the same number (75%) say that genetic testing allows for more personalized medical decisions and more targeted therapies.

The survey shows, however, questions among physicians about the costs of genetic tests. Six in 10 (59%) physicians say they are very concerned about the costs of genetic tests to their patients, although only two in 10 (21%) expressed concerns about reimbursements for their tests. More than half (56%) expect genetic testing will eventually increase the cost of health care, while two in 10 (19%) believe testing will reduce health care costs.

American adults in general show somewhat similar patterns when asked about genetic testing. Only about one in 20 adults (6%) report having a genetic test themselves and one in 10 (10%) say a family member has been tested. However, large majorities of American adults believe that genetic testing allows for more personalized medical decisions (77%) and testing gives doctors the ability to diagnose conditions that can be prevented (78%).

UnitedHealthcare says its own data show the cost of claims for genetic and molecular diagnostic testing came to $500 million in 2010, with spending per UnitedHealthcare member increasing about 14 percent a year between 2008 and 2010. Medicare and Medicaid members, says the company, spent more per person on genetic tests than commercially sponsored insurance customers.

Extrapolating to the U.S. as a whole, UnitedHealthcare estimates the country spent about $5 billion on genetic testing in 2010, or about 8 percent of all spending on clinical laboratory services. The analysts simulated cost projections over the next 10 years based on three potential growth scenarios, and estimate genetic testing would end up costing between $15 and $25 billion total by 2021.

Disclosure: The author is insured by UnitedHealthcare

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