Page 166 - Genomic Medicine in Emerging Economies

Conclusion and Future Perspectives 155

CONCLUSION AND FUTURE PERSPECTIVES

The above examples suggest that pharmacogenomic economic evaluation stud-
ies must be replicated in every country to inform policymakers prior to the
implementation of a pharmacogenomic-guided medical intervention, follow-
ing the evaluation of its cost-effectiveness based on characteristics specific to
each country. This is a daunting expectation given the rapidly increasing num-
ber of pharmacogenomics guidelines of developed countries’ regulatory agen-
cies, such as the US FDA, and multinational organizations, such as the Clinical
Pharmacogenetics International Consortium, not to mention that many devel-
oping countries do not have the necessary resources and expertise to perform
the analyses. This issue could be minimized by the construction of generic eco-
nomic models that would allow input of certain key variables, such as allele
frequency and test and treatment costs that vary by country. This model could
be used by less experienced individuals who have access to the country-specific
variables to generate a first approximation of cost-effectiveness, allowing priori-
tization between different emerging tests. The decrease of genotyping costs for
the once-in-a-lifetime determination of an individual’s personalized pharma-
cogenomics profile, using next generation sequencing technologies including
whole genome sequencing, would gradually result in a cost-effective pharma-
cogenomics-guided treatment for drugs bearing pharmacogenomic testing rec-
ommendations on their labels, as the single test could provide information that
would inform prescribing choices over the lifetime of a patient.
In addition, the application of population pharmacogenomics would contrib-
ute toward making pharmacogenomics a useful tool, which could be incor-
porated into the clinical practice of every country. In particular, to close the
disparity in practical use of pharmacogenomics in the developing world, such
approaches (e.g., the Euro-PGx project) would help toward (1) enhancing
the understanding of pharmacogenomics in the developing world, (2) pro-
viding guidelines for medication prioritization, and (3) building infrastruc-
ture for future pharmacogenomic research studies. Such projects would serve
to enhance the understanding of pharmacogenomics globally. Although the
Euro-PGx project, coordinated by the Golden Helix Foundation (see also
Chapter 9), only represents the European continent, officially launched in
2010 and successfully completed in 2016 (Mizzi et al., 2016), it provides the
basis for replication in individual countries; similar projects are already about
to be launched in other geographical regions, such as the 1000 Pharmacogenes
project in Southeast Asia, under the umbrella of the Golden Helix Foundation
and the Global Genomic Medicine Collaborative. Other initiatives, such as the
Human Heredity and Health in Africa (H3Africa), the Qatar Genome Project,
and the Mexico National Institute of Genomic Medicine (INMEGEN) aimed
to address such issues through capacity building and empowerment of local
researchers to spark a paradigm shift.