Test to Select Anxiety Medication Saves Money, Study Finds

Patients often try, and fail, on medications before settling on one that works for anxiety or depression. A new test can help physicians select the correct medication the first time.

Physicians treating behavioral health disorders often struggle to select the right medication; because symptoms are difficult to measure, patients may try several drugs before settling on one that proves effective. This creates waste and unnecessary expense, both for health plans and for patients.

A test developed by Assurex Health, recently acquired by Myriad Genetics, can help physicians match medications with a patient’s genetic profile to guide treatment for depression, anxiety, schizophrenia, and other mental health disorders.

According to a press release from Myriad, Assurex recently presented results for the test, called GeneSight, in a poster at the Neuroscience Education Institute, held November 3-6, 2016, in Colorado Springs, Colorado.

In the study, researchers looked at the cost of treatment for a total of 318 patients with generalized anxiety disorder who took part in an earlier study involving the GeneSight test. Patients were divided into 2 groups: in the first group, treatment decisions aligned with information from the test, and in the other group, decisions were not based on the test.

For the first group, treatment costs were $5736 per year, compared with $12,483 per year for the second group, for a savings of $6747 (P <.004). The patients with generalized anxiety disorder saw savings across multiple medication categories: central nervous system medications (savings were 2-fold), antineoplastic medications (savings were 2.5-fold), and gastroenterology medications (savings were 2.8-fold). The study noted that most of the savings came from drugs used in primary care.

Behavioral health decisions are often made in primary care settings, especially for patients diagnosed with anxiety and depression. In fact, the Substance Abuse and Mental Health Services Administration refers to primary care as the “gateway” for mental health services, and has promoted greater integration of care. However, some studies show that patients in primary care can experience “clinical inertia,” because physicians often do not increase doses of antidepressants or change medications as quickly as they should. Thus, patients may not experience as much improvement as possible, or they may become frustrated and stop taking their medication.

According to the press release, a previously published study found that use of the GeneSight test improved medication adherence and reduced polypharmacy, which, in turn, contributed to cost savings.

Payers, including CMS, are taking steps to promote behavioral health in primary care settings. In the 2017 Medicare Physician Fee Schedule, federal officials approved codes for collaborate care, which puts the mental health visit in the primary care setting. According to information from Myriad spokesman Ron Rogers, Assurex has sought an application for an expanded local coverage determination (LCD) from Medicare for primary care physicians to order GeneSight.

“If we are successful at obtaining an expanded LCD, we will launch this indication with our current preventive team, which would represent upside to our guidance,” Rogers said in an e-mail.

GeneSight test volume for September reached 18,000, which was a 70% increase from the same month in 2015, according to the company.