Implementation of Pharmacogenomics Guided Warfarin Dosing and INR monitoring for Hospitalized Patients: Focus on Health Economics and Adverse Event Rates
Patient Safety and Quality of Care
TRANSFORMATION: Currently, drug therapy is a “shotgun” or iterative approach. Implementation of Personalized Medicine (PM)-based patient care can enhance drug safety and effectiveness, while lowering overall health care costs through reduced hospitalizations and clinic visits.
ADOPTABILITY: Our PM approach that leverage expert physicians, pharmacists, and nurses as well as genomics technologies is scalable and adoptable to other hospitals across Ontario.
- Decrease the average length of stay (ALOS) in patients prescribed drug such as warfarin.
- Improvement in metrics adverse events, such as bleeding events, emergency room visits, and hospitalizations.
- Increase the standardization of care and reduce variability for patients prescribed drugs such as warfarin.
Background: In acute can hospital settings across North America, serious adverse drug reactions (ADRs) are observed in 6.7% of patients, and considered to be the 4th leading cause of death (Lazarou J, Pomeranz B, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA 1998;279:1200–1205).
Warfarin is a drug used in the prevention and treatment of blood clotting in patients and results in the largest number of drug related admissions in tertiary hospitals.
Methods: Our personalized care team supported by the current AMOSO Innovation Fund, provided genomic-guided warfarin dosing and recommendation for 152 patients, and on target for 200 patients over a 2 year funding period.
Results: Interim analysis shows mean length of stay (LOS) in hospital was 14.8 days. When our PM inpatient consult service is involved for the initiation of warfarin dosing, average length of hospital stay is reduced by 2-3 days. We have carried out detailed case costing and determined that even if we reduce the length of stay (LOS) by one day (last day of the stay), this will result in an average direct cost savings of $776/patient for those who are admitted under cardiology and $616/patient for clinical teaching unit (CTU-Medicine).
Conclusions: We are now able to demonstrate that implementation of personalized medicine-based approach is a viable and cost effective solution for tertiary care hospitals for high risk drugs such as warfarin.
Future Direction: Our PM team has created an in-depth Personalized Medicine Clinical Strategy Business Plan that includes Work Breakdown Structure, Project Implementation Schedule, Communication Plan, as well as a potential funding model, and we are on track to proceed with hospital-wide PM approach.