Genetic Testing: Another Reason Why It's Not Likely To Lower Costs

Today’s Managing Health Care Costs Number is $299

A number of genetic testing companies suggest that doing genetic testing on individuals or an employee workforce could lower overall health care costs.  The cost of these tests ranges from $299 to $999.

Here’s how this works in theory.   Some people will be found to have genetic predisposition to react badly to some medications, or to need higher or lower doses of these medications.  Doing genetic tests would help individual employees get the best drug for their personal genetic traits in categories including antidepressants and blood thinners.   Further, genetic test could motivate behavior change when some people discover they are at higher genetic risk for certain diseases, including diabetes or heart disease.

The savings claims seem highly unlikely.

The General Accountability Office sent DNA samples from its own employees to multiple genetic testing companies, using both real and fictitious demographic and medical information. The GAO found that there were wild inconsistencies among the companies, and the genetic counseling advice offered was deeply flawed or worse. 

I’m especially interested in the “scared skinny” argument.  This argument goes that when shown evidence that she is at higher risk of diabetes, a test subject will go out and increase exercise and lose weight.    I’m skeptical, of course, since many people already see their parents suffer the complications of diabetes –and that would seem to me to have far more impact than a genetic test report!

The New England Journal of Medicine  published an article on its website this week reporting on 3600 people who personally paid for the Navigenics genetic testing package.   The article focuses on over 2000 people who had the genetic test and then completed 3 month followup surveys. The researchers looked at lifestyle behavior change subsequent to getting the results of the genetic tests, and compared those at high vs. low risk for various conditions.

The good news is that few people had test related distress or anxiety (9.3%) or clinically significant test related anxiety (2.8%) when they got their results.

The bad news (and you have to read the supplementary appendix to see the actual results) is that people found to be at increased genetic risk for obesity increased their intake of fatty foods after receiving the test results.  The only other significant findings related to risk conditions were those at higher risk of breast cancer had decreased exercise and increased their fat intake.  Those found to be at risk for  aneurisms, heart attacks, strokes, and diabetes did not make any significant changes in their lifestyles based on the result of these tests.

Genetic testing is likely to play an important future role in ascertaining the best medical care for each of us as individuals.  This study undermines one of the arguments to do widespread genetic testing right now.   There is no reason to encourage an unselected low risk population to get genetic testing at this point.

By the way, here's a link to a post from two years ago pointing out that genetic testing was promised to save money for those on blood thinners, but rigorous studies showed increased cost.