Cost, ease of use cited as primary barriers for genetic testing in CKD diagnosis
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Despite a steady decrease in cost over time, a survey of nephrologists revealed cost and ease of use/availability as the most significant barriers to genetic testing for chronic kidney disease in clinical practices.
The study, published in Kidney Medicine, showed that 72% of respondents reported use of genetic testing in their practices. However, nearly half of genetic test users and nearly 70% of non-users cited cost as a key barrier to use of genetic testing.
“Together, the perception of high utility but low use of genetic testing suggests significant barriers are preventing broader use by nephrologists,” Michal Mrug, MD, professor of medicine in the division of nephrology at the University of Alabama at Birmingham, and colleagues wrote in the study. “Our study pointed to several logistical perceived barriers, of which, the most prominent was the cost of genetic tests.”
Mrug and colleagues surveyed 149 nephrologists with valid board certifications in the United States. The survey included 29 questions consisting of multiple choice, fill-in-the-blank and ranking questions regarding the significance and accessibility of genetic testing in nephrology. For questions about potential barriers to genetic testing, participants were asked to rank each potential answer from one (not a barrier) to five (significant barrier), while also ranking different types of support for obtaining genetic testing from one (not important) to five (extremely important). The survey also assessed different clinical instances in which genetic testing could hold value. For these, participants could select multiple categories.
Researchers found 35% of responders without a history of genetic test use ranked the barriers to genetic testing as “extremely significant” compared with 23% of genetic test users who gave the same ranking. In addition to cost, 33% of test users and 57% of non-users cited availability/ease of use as a key barrier to use. Regarding the importance of genetic testing in clinical practice, most responses indicated that genetic testing was most valuable for patients with specific clinical diagnoses (75% of genetic test users and 86% of non-users) and for the evaluation of patients with CKD of unknown etiology (69% users and 38% of non-users).
Researchers noted data from the National Genome Research Institute show the cost of sequencing one megabase in next-generation sequencing (NGS) has decreased from $5,292.39 in 2001 to $0.008 in 2020.
“Although our study did not include analysis of the perceived costs of genetic testing, the rapid decline in costs of NGS as well as the expansion in testing options suggests that continued education around the cost-effectiveness of genetic testing is needed,” Mrug and colleagues wrote.
According to the study, education provided by genetic counselors, laboratories that use genetic testing and other experts can potentially benefit both physician hesitancy in obtaining and using genetic testing and patient concern, increasing the amount of testing use among nephrologists in CKD treatment.
“These observations may support the development of educational programs catered toward increased appreciation of using genetic tests, which may help with patient management and improved formal practical guidance for the use of genetic testing in nephrology practice,” Mrug and colleagues concluded.
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