[Pharmacogenetics--implications for health management and health care economics]

Pharmacogenetics, which is principally concerned with drug efficacy and safety, will change the way future health care is practiced. The growing understanding of the genetic basis for drug response and use of this knowledge to predict the response of an individual patient offer new opportunities to meet the changing needs of health care systems and the demands placed upon them. For the individual patient, overall quality of life should be higher as physicians will be able to select the most effective and safest treatments for them. However, the cost of patient evaluation will need to be weighed against the additional therapeutic benefit and savings made by avoidance of unnecessary and inadequate drug use and adverse drug responses. Getting the right medicine at the right dose to the patient first time and avoidance of "try and see" prescribing also have the potential to reduce costs due a reduction in number of visits to the physician required to obtain satisfactory treatment. Application of pharmacogenetics to drug development has the potential to streamline the drug development process. Disease and therapy differentiation may lead to stratification of patient groups, and it is possible that the fragmented indications will not represent commercially attractive markets to the pharmaceutical industry with current marketing paradigms. However, the ability to target patients more accurately may represent considerable commercial value within a given market sector. Changes in health care policy and structure will be needed so that short-term budget constraints are not allowed to take precedence over mid- to long-term benefits. In order to realize the potential of pharmacogenetics, tailored communication/education programs for the key stakeholders--patients and patient groups, health care professionals, regulators, health care industry (biotechnology, pharmaceutical and diagnostic companies), health care payers, governments, and academia--will be necessary. Pharmacogenetics is likely to be introduced according to need, clinical validity and value, with resources first being directed at diseases for which it is vital to prescribe the right drug at the right dose from the outset, e.g. in cancer.