A prognostic model based on readily available clinical data enriched a pre-emptive pharmacogenetic testing program.

Schildcrout JS, Shi Y, Danciu I, Bowton E, Field JR, Pulley JM, Basford MA, Gregg W, Cowan JD, Harrell FE, Roden DM, Peterson JF, Denny JC
J Clin Epidemiol. 2016 72: 107-15

PMID: 26628336 · PMCID: PMC4779720 · DOI:10.1016/j.jclinepi.2015.08.028

OBJECTIVES - We describe the development, implementation, and evaluation of a model to pre-emptively select patients for genotyping based on medication exposure risk.

STUDY DESIGN AND SETTING - Using deidentified electronic health records, we derived a prognostic model for the prescription of statins, warfarin, or clopidogrel. The model was implemented into a clinical decision support (CDS) tool to recommend pre-emptive genotyping for patients exceeding a prescription risk threshold. We evaluated the rule on an independent validation cohort and on an implementation cohort, representing the population in which the CDS tool was deployed.

RESULTS - The model exhibited moderate discrimination with area under the receiver operator characteristic curves ranging from 0.68 to 0.75 at 1 and 2 years after index dates. Risk estimates tended to underestimate true risk. The cumulative incidences of medication prescriptions at 1 and 2 years were 0.35 and 0.48, respectively, among 1,673 patients flagged by the model. The cumulative incidences in the same number of randomly sampled subjects were 0.12 and 0.19, and in patients over 50 years with the highest body mass indices, they were 0.22 and 0.34.

CONCLUSION - We demonstrate that prognostic algorithms can guide pre-emptive pharmacogenetic testing toward those likely to benefit from it.

Copyright © 2016 Elsevier Inc. All rights reserved.

MeSH Terms (25)

Adult Aged Age Factors Clopidogrel Decision Support Systems, Clinical Drug Utilization Electronic Health Records Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors Longitudinal Studies Male Middle Aged Models, Statistical Pharmacogenetics Predictive Value of Tests Prognosis Program Evaluation Proportional Hazards Models Reproducibility of Results Risk Factors Sex Factors Ticlopidine United States Warfarin

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