By performing pharmacogenetic (PGx) testing, it is possible to lower the risk of toxicity and increase the chance of an effective outcome by personalising a prescription based on a person’s genetic status. Due to concerns over the underutilisation of this type of testing in Australia, the RCPA is leading an initiative to create new guidelines for PGx testing along with a framework for applications to the Medical Services Advisory Committee (MSAC). Professor Graeme Suthers is the RCPA representative for the initiative, funded by Australian Genomics.

“Australians are currently missing out on the significant benefits of PGx testing, which has been proven to improve positive health outcomes for many diseases, including depression, cardiovascular disease, cancer, epilepsy and gout.

“The significance of PGx is huge, yet Australia is currently falling behind in this area. We are at the point now where patients are missing out on potentially improved health outcomes because PGx testing is not being utilised widely enough. One of the main barriers we face in Australia is that whilst PGx testing has potential application in most areas of healthcare, most clinicians are unaware of the recent advances in PGx and their impact on clinical practice. Through this initiative we therefore aim to provide clinicians with guidance on when to use PGx testing.

“Although international guidelines have been established for PGx testing, there is currently no guidance on when to perform the test in Australia. This very much depends on what happens locally in terms of willingness to pay, access to tests, expertise available, what drugs are available etc.,” said Prof Suthers.

PGx has been used for a number of years in other countries and is now considered mainstream across the US, UK and Europe.

“Clinical trials have now confirmed that PGx testing has the potential to improve positive health outcomes, avoid negative outcomes and can also be cost-saving. Indirect studies have estimated that adverse drug reactions and inadequate drug responses cost the Australian Health system in excess of one billion dollars a year. There would also be further substantial savings from avoiding wastage of drugs and from improved health outcomes for patient.

“This is not trivial. We urgently need to expand the implementation of PGx testing to elevate the quality of care we offer to patients. If someone has an uncommon yet predictable reaction to a drug, they are going to be asking why wasn’t a PGx test done. There have been some court cases in the US where patients have had adverse reactions to medications and have sued the hospital for failing to do the right PGx test. We don’t want to be in that situation in Australia,” said Prof Suthers.

Currently, the main source of funding PGx tests is the patient, without there being any recourse to a rebate from State or Federal Governments, or from insurers. As part of the initiative, the RCPA will also establish a framework for applications to the Medical Services Advisory Committee (MSAC) for PGx testing, including two submissions for the Medicare Benefits Schedule (MBS) funding for the most urgent PGx tests.

“Limited PGx testing is available currently in Australia, both as gene panel screening and targeted genotyping, predominantly through private services at present. By establishing a framework for PGx applications, the RCPA aims to improve access for patients,” said Prof Suthers.