Can personalised prescribing deliver a new, modern healthcare system? Rich Quelch, Global Head of Marketing at Origin, examines the evidence. 

With up to 6.5%¹ of UK hospital admissions a result of adverse drug reactions – and prescription medicines failing to work altogether on up to half of patients – the call for personalised prescribing is growing.

A recent report² by the British Pharmacological Society and the Royal College of Physicians even called for pharmacogenomic testing to be integrated fully, fairly and swiftly into the NHS, where prescriptions are tailored to our unique genetic make-up.

By taking a pharmacogenomic approach, healthcare providers can not only confidently administer, or avoid, drugs but gain a deeper understanding of patient responses – allowing for the right treatments to be prescribed at the right time, in the right doses.

But what are the key costs, challenges and implications of delivering this personalised healthcare model and what would it look like in reality?

Getting personal with pharmacogenomics
Since its inception in 1948, the way the NHS manages prescribing services has remained largely unchanged. However, away from the waiting room, things have moved on.

While technologies and science has evolved, we continue to prescribe medicines and treatments based on a universal understanding of their benefits. But slowly, the importance of genetic make-up and how that affects the intended treatment is evolving.

It’s increasingly accepted that a one-size-fits-all approach to prescribing is not only inefficient but can be harmful. For example, common drugs such as antibiotics and anti-inflammatory medicines, and even advanced treatments like chemotherapy drugs, are all known to produce negative side effects in patients carrying, or without, certain genes.     

And others may simply lack the gene that makes certain medicines, such as codeine, effective. This not only results in a waste of funding and materials but leaves patients without the crucial painkilling quality.

Another piece of genetic research has also revealed a rare variation in one gene can cause an excessive immune reaction³ when exposed to a variety of common medications. And the bodily response for those carrying this variation while medicating can result in liver damage.

Without pharmacogenomics, the risk to patients is real – with hundreds of deaths each year⁴ in the UK alone attributed directly to adverse drug reactions.

So, is it time for a paradigm shift towards a new, purpose-built model? Not only could personal prescribing maximise medical efficacy and improve patient outcomes, it could also reduce spending and over-prescribing in the NHS.

However, the challenge is overhauling the way the health service operates. And this comes at a time of growing ill health and NHS waiting lists at all-time highs⁵ – with the service at the limits of affordability.

“Without pharmacogenomics, the risk to patients is real”

Difficult, but not impossible barriers to overcome
While the authors of the Personalised Prescribing – Using pharmacogenomics to improve patient outcomes report call for pharmacogenomics to become a reality for all NHS Trusts, it’s not as simple as testing patients when they arrive at a doctor’s surgery or hospital.

Current iterations of genome tracing projects – including established tests before the administering of HIV medication, as well as multiple NHS projects⁶ aimed at sampling patient genomes – have revealed the key challenges.

The primary challenge being funding – particularly in the research needed to develop an efficient and scalable genetic testing solution. Then comes additional financial and logistic barriers in the training needed at every level of the health service, from using equipment to interpreting and communicating findings.

The long-term rewards far outweigh short-term costs, though. And it’s estimated that, while genetic testing could cost up to £150 per patient, the savings will be much greater – especially considering adverse drug reactions are believed to cost the NHS up to £2 billion every year¹.

After establishing a workable model, further challenges include engaging the public and overcoming confidentiality concerns and stigma around genetic testing. Plus, outsourcing key logistics services may also encounter speedbumps, for example, in the manufacturing and supply of equipment.

These may include the development of accurate and compliant medical devices, with healthcare regulations threatening to delay or prohibit the use of equipment that doesn’t meet industry standards.

Similarly, the $200 billion pharmaceutical fraud market⁷ poses additional complications and disruption. Then there are common supply chain challenges including transparency and communication, and unforeseen delays.

However, working with agile supply chains – such as those operating an ‘all-under-one-roof’ model – could help to avoid bottlenecks and delays, increase speed and efficiency and, importantly, reduce costs, delivering a truly personal NHS service.

Ethical considerations
Finally, the concept and delivery of genetic testing also raises ethical questions.

These include the implications surrounding secondary or incidental findings (those that don’t relate to the primary reason for testing), as well as the risk of unclear or incomplete findings. Is it morally sound to administer or withhold treatment based on genetic data that is incomplete or may be subject to further exploration?

While these are valid considerations, the further exploration of genetic testing will yield ethically sound frameworks when it comes to the collection, delivery and use of patient data. 

References

¹  www.theguardian.com/science/2022/mar/29/experts-push-for-genetic-testing-to-personalise-drug-prescriptions

² www.bps.ac.uk/about/our-campaigns/personalised-prescribing

³ www.sciencedirect.com/science/article/pii/S0016508516355305

⁴ www.manchester.ac.uk/discover/news/more-than-200-million-medication-errors-occur-in-nhs-per-year-say-researchers

⁵  www.theguardian.com/society/2022/apr/14/number-of-people-on-nhs-waiting-lists-in-england-at-record-high#:~:text=NHS%20data%20shows%206.2%20million,waiting%20more%20than%20two%20years.

⁶ www.england.nhs.uk/genomics/nhs-genomic-med-service/#:~:text=To%20be%20the%20first%20national,with%20a%20likely%20genetic%20disorder.

⁷ www.sciencedirect.com/science/article/pii/S2666535222000167#bib7side