Considerations for the reimbursement of Pharmacogenomic testing in Ontario Psychiatry
This report examines the potential of pharmacogenomic testing to improve psychiatric care in Ontario, highlighting patient experiences, clinical utility, and policy considerations for future reimbursement strategies.
Background
For 34-year-old Gwen1, a long-time patient of Ontario, Canada’s mental healthcare services, genetic testing was a final hope: “I was diagnosed nearly 12 years ago during a dark and scary time. Over the next decade, I tried every treatment imaginable – including dozens of medications and electroconvulsive therapy – before running out of options. I felt hopeless and alone. I started to think it was pointless to put so much effort into recovery when nothing seemed to help...I have personally tried at least 25 medications over the years…I can speak to the time and suffering saved by genetic testing…[.]”2 Unfortunately, stories such as Gwen’s are not uncommon among those suffering from mental illness. Despite incredible advances in the neurosciences and psychological sciences, many of the most essential operations of the human brain remain enigmas. Among these mysteries are the precise ways in which many medications, especially those used to treat mental illnesses, or, ‘psychotropics’, affect the brain, body, and behaviour of humans. Consequently, many psychiatrists, as well as physicians in other clinical disciplines, adopt a ‘trial-and-error’ approach to prescribing medications. Trial-and-error combines the physician’s professional experience with their knowledge of existing medications and standards of care to determine the most appropriate medication for a given patient. Thereafter, physicians adjust the dose of the medication — or, in many cases, alter the prescription itself — based on the patient’s response thereto (Mrazek, 2010). Medication trials stop either when the patient is deemed to be a ‘non-responder’ or when intolerable side effects occur. Pharmacogenomics is the study of the influence of genetic variants on individual responses and side effects to medication. Since its inception in the 1950s, pharmacogenomic testing has become an increasingly viable mitigator of trial-and-error prescriptions. Pharmacogenomic testing has significant potential to improve psychiatric treatment by increasing the likelihood that a patient will receive an effective and suitable medication early in their treatment journey. Accordingly, there is significant potential for these tests to improve psychiatric patients’ treatment experience. This report discusses the evidence in support of pharmacogenomic testing, including cost-effectiveness and clinical utility, and describes a study that will assess the Ontario patient need for pharmacogenomic testing.
The two phases of this study present opportunities for:
- Patient engagement regarding their need(s) for pharmacogenomic testing in present and future psychiatric treatment and
- Strategic ideation with key stakeholders in pharmacogenomics concerning ways in which to address these needs collaboratively
Ultimately, we expect these data to provide important reference material for companies that sell pharmacogenomic tests in Ontario (and beyond), as well as psychiatrists, other physicians, and policymakers.
Project team
- Catherine Virelli
TRP supervisors
Project advisory committee
- James Kennedy
- Melanie Barwick
- Jennifer Bell
- Kwamie Mackenzie
See our community directory for more on committee members.