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Reflections on the Cost Consequences of the New Gene Technology for Health Policy

Published online by Cambridge University Press:  10 March 2009

Pauline Vaillancourt Rosenau
Affiliation:
University of Texas—Houston School of Public Health

Abstract

This article presents a preliminary and necessarily tentative and subjective assessment of the impact of new gene technology on health care costs. In the short term, diagnosis and treatment of genetic disease are likely to increase costs. Treatment with nongene therapy will continue to be far less expensive than gene therapy where it is available. Research developments to monitor as indicators of forthcoming cost reductions in genetic therapy are set forth. Some forms of genetic screening may soon reduce health care costs, and an example is provided. Genetically engineered Pharmaceuticals are described and their impact on costs reviewed. Conditions under which they are likely to reduce health care costs are indicated.

Type
Special Section: Genetic Technology
Copyright
Copyright © Cambridge University Press 1994

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References

REFERENCES

1.AMA Council on Ethical and Judicial Affairs. Use of genetic testing by employers. Journal of the American Medical Association, 1991, 266, 1827–30.CrossRefGoogle Scholar
2.Anderson, C.Research and health care costs. Science, 1993, 261, 416–18.CrossRefGoogle ScholarPubMed
3.Anderson, W. F.Uses and abuses of human gene transfer. Human Gene Therapy, 1992, 3, 12.CrossRefGoogle ScholarPubMed
4.Anderson, W. F.Human gene therapy. Science, 1992, 256, 808–13.CrossRefGoogle ScholarPubMed
5.Angiers, N. With direct injections gene therapy takes a step into a new age. New York Times, 04 14, 1992, B6.Google Scholar
6.Angiers, N. A pivotal gene commands cells to grow or die. New York Times, 1992, B1, B8.Google Scholar
7.Angiers, N. Clues to longevity found at chromosome tip. New York Times, 1992, B7, B11.Google Scholar
8.Angiers, N. Gains made in effort to map the human genetic makeup. New York Times, 1992, A1, A22.Google Scholar
9.Angiers, N. Cystic fibrosis experiment hits a snag. New York Times, 1993, B9.Google Scholar
10.Ballantyne, J., Sensabaugh, G., & Witkowski, J. (eds.). DNA technology and forensic science. Cold Spring Harbor, NY: Cold Spring Laboratory Press, 1989.Google Scholar
11.Beaudet, A. L., Scriver, C. R., Sly, W. S. et al. , Introduction to human biochemical and molecular genetics. New York, NY: McGraw-Hill Inc., 1990.Google Scholar
12.Becker, M. H. Psychosocial aspects of health-related behavior. In Freeman, H. E., Levine, S., & Reeder, L. G. (eds.), Handbook of medical sociology. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1979, 253–74.Google Scholar
13.Beutler, E.Gaucher disease: New molecular approaches to diagnosis and treatment. Science, 1992, 256, 794–98.CrossRefGoogle ScholarPubMed
14.Bishop, J., & Waldhol, M.Genome: The story of the most astonishing scientific adventure of our time — The attempt to map all the genes in the human body. New York: Simon & Schuster, 1990.Google Scholar
15.Bodmer, W.Cancer genetics and the human genome. Hospital Practice, 1991, 26, 101–20.CrossRefGoogle ScholarPubMed
16.Boulding, K.The concept of need for health services. Milbank Memorial Fund Quarterly, 1966, 44, 157220.CrossRefGoogle ScholarPubMed
17.Cambien, F., Poirier, O., & Laure, L.Deletion polymorphism in the gene for angiotensin-converting enzyme is a potent risk factor for myocardial infarction. Nature, 1992, 359, 641–44.CrossRefGoogle ScholarPubMed
18.Carter, B., Beaty, T., Steinberg, G. et al. , Mendelian inheritance of familiar prostate cancer. Proceedings of the National Academy of Sciences of the United States of A merica 1992, 89, 3367–71.CrossRefGoogle Scholar
19.Caskey, C. T.Physician-laboratory interface in x-chromosome mapping. Hospital Practice, 1991, 26, 131–44.CrossRefGoogle ScholarPubMed
20.Caskey, C. T. DNA-based medicine: Prevention and therapy. In Kevles, D. J. & Hood, L. (eds.), The code of codes. Cambridge, MA: Harvard University Press, 1992, 336.Google Scholar
21.Caskey, C. T.Molecular medicine: A spin-off from the helix. Journal of the American Medical Association, 1993,269, 1986–92.CrossRefGoogle ScholarPubMed
22.Caskey, C. T. & Hammond, H. DNA-based identification: Disease and criminals. In Ballantyne, J.Sensabaugh, G. & Witkowski, J. (eds.), DNA technology andforensic science. Cold Spring Harbor, NY: Cold Spring Laboratory Press, 1989, 127–37.Google Scholar
23.Chumakov, I.Continuum of overlapping clones spanning the entire human chromosome. Nature, 1992, 359, 380–86.CrossRefGoogle ScholarPubMed
24.Cloninger, C. R.D2 dopamine receptor gene is associated but not linked with alcoholism. Journal of the American Medical Association, 1991,266, 1833–34.CrossRefGoogle Scholar
25.Collins, F. S.Identification of disease genes: Recent successes. Hospital Practice, 26, 93100.CrossRefGoogle Scholar
26.Collins, F. S.Cystic fibrosis: Molecular biology and therapeutic implications. Science, 1992, 256, 774–78.CrossRefGoogle ScholarPubMed
27.Comings, D. E. et al. The dopamine D2 receptor locus as a modifying gene in neuropsychiatric disorder. Journal of the American Medical Association, 1991, 266, 1793–99.CrossRefGoogle Scholar
28.Conneally, P. M.A first step toward a molecular genetic analysis of amyotrophic lateral sclerosis. New England Journal of Medicine, 1991, 324, 1430–34.CrossRefGoogle Scholar
29.Corral-Debrinski, M.Hypoxemia is associated with mitochondrial DNA image and gene induction: Implications for heart disease. Journal of the American Medical Association, 1991, 266, 1812–16.CrossRefGoogle Scholar
30.Counter, C.Avillion, A.LeFeuvre, C. et al. Telomere shortening associated with chromosome instability is arrested in immortal cells which express telomerase activity. EMBO Journal, 1992, 11, 1921–29.CrossRefGoogle ScholarPubMed
31.Culhane, C. Will there be a market for genetic testing in insurance. American Medical News, 01 13, 1992, 29.Google Scholar
32.Culver, K. Splice of life. The Sciences, 1993, 1824.CrossRefGoogle Scholar
33.Davies, K. E. & Read, A. P.Molecular basis of inherited disease. Washington, DC: IRL Press, 1988.Google Scholar
34.Department of Health and Human Services. Alcohol and health: Seventh special report to the U.S. Congress. Rockville, MD: U.S. Dept. of Health and Human Services, 1990.Google Scholar
35.Economist. The tiniest transplants. Economist, 1992, 323, 9597.Google Scholar
36.Elkington, J.The gene factory: Inside the science and business of biotechnology. New York: Carroll & Graf Publishers, Inc., 1985.Google Scholar
37.Fisher, L. Inside human cells, a new frontier. New York Times, 01 24, 1993, 9.Google Scholar
38.Fisher, L. Immune-cell modification outside the body. New York Times, 01 19,1992, A1.Google Scholar
39.Gasser, C. & Fraley, R.Transgenic crops. Scientific American, 1992, 266, 6269.CrossRefGoogle Scholar
40.Gibbons, A.Biotech’s second generation. Science, 1992, 256, 766–68.CrossRefGoogle ScholarPubMed
41.Gilbert, W.DNA sequencing, today and tomorrow. Hospital Practice, 1991, 26, 165–74.CrossRefGoogle ScholarPubMed
42.Goldman, D.Clarke, A. & Garber, A.Creating the costliest orphan: The Orphan Drug Act in the development of Ceredase. International Journal of Technology Assessment in Health Care, 1992, 8, 583–97.CrossRefGoogle ScholarPubMed
43.Gordis, E.From science to social policy: An uncertain road. Journal of Studies on Alcohol, 1991,52, 101–09.CrossRefGoogle ScholarPubMed
44.Greeley, H. Health insurance, employment discrimination, and the genetics revolution. In Kevles, D. J. & Hood, L. (eds.), The code of codes, Cambridge, MA: Harvard University Press, 1992, 264–80.Google Scholar
45.Green, E. & Waterston, R.The Human Genome Project: Prospects and implications for clinical medicine. Journal of the American Medical Association, 1991, 266, 1966–75.CrossRefGoogle ScholarPubMed
46.Hall, J. Impact of genetic disease on pediatric health care. In Kaback, M. & Shapiro, L. (eds.) Frontiers in genetic medicine. Report of the 92nd Ross Pediatric Research Conference. Columbus, OH: Ross Laboratories, 1987.Google Scholar
47.Handyside, A. H., Lesko, J., Tarin, J. et al. , Birth of a normal girl after in vitro fertilization and preimplantation diagnostic testing for cystic fibrosis. New England Journal of Medicine, 1992, 327, 905–09.CrossRefGoogle ScholarPubMed
48.Hayes, A., Costa, T., Scriver, C. R., & Childs, B.The effect of mendelian disease on human health. II: Response to treatment. American Journal of Medical Genetics, 1985, 21, 243–55.CrossRefGoogle ScholarPubMed
49.Hilts, P. Head of gene map threatens to quit. New York Times, 04 9, 1992, A9.Google Scholar
50.Hofman, K., Tambor, E., Chase, G. et al. , Physicians’ knowledge of genetics and genetic tests. Academic Medicine, 1993, 68, 625–32.CrossRefGoogle ScholarPubMed
51.Holtzman, N. A.Proceed with caution: Predicting genetic risks in the recombinant DNA era. Baltimore, MD: Johns Hopkins University Press, 1989.Google Scholar
52.Hubbard, R., McElvaney, N., Birrer, P. et al. , A preliminary study of aerosolized recombinant human deoxyribonuclease I in the treatment of cystic fibrosis. New England Journal of Medicine, 1992, 327, 812–15.CrossRefGoogle Scholar
53.Industrial Biotechnology Association. Biotechnology at work: Diagnostics. Washington, DC: Industrial Biotechnology Association, 1988.Google Scholar
54.Industrial Biotechnology Association. Medicine and the new biology. Washington DC: Industrial Biotechnology Association, 1988.Google Scholar
55.Jeunemaitre, X., Soubrier, F., Kotelevtsev, Y. et al. , Molecular basis of human hypertension: Role of angiotensinogen. Cell, 1992, 71, 169–80.CrossRefGoogle ScholarPubMed
56.Juengst, E.Priorities in professional ethics and social policy for human genetics. Journal of the American Medical Association, 1991, 266, 1835–36.CrossRefGoogle ScholarPubMed
57.King, M.-C.Localization of the early-onset breast cancer gene. Hospital Practice, 1991, 26, 121–30.CrossRefGoogle ScholarPubMed
58.Kolata, G. Genetic defects detected in embryos just days old. New York Times, 09 24, 1992, A l.Google Scholar
59.Kushner, J.A first step toward a molecular genetic analysis of amyotrophic lateral sclerosis. New England Journal of Medicine, 1991, 324, 1430–34.Google Scholar
60.Kwak, L., Campbell, M., Dzerwinski, D. et al. , Induction of immune responses in patients with B-cell lymphoma against the surface-immunoglobulin idiotype expressed by their tumors. New England Journal of Medicine, 1992, 327, 1209.CrossRefGoogle ScholarPubMed
61.Lampton, C.Gene technology: Confronting the issues. New York, NY: Franklin Watts, 1990.Google Scholar
62.Ledley, F. D.Novel approaches to somatic gene therapy. Seminar Lecture Series, Department of Cell Biology and Immunology, M.D. Anderson Cancer Center. Houston, TX, 09 21, 1993.Google Scholar
63.Lewontin, R. C.The dream of the human genome. New York Review, 05 28, 1992, 39, 3140.Google ScholarPubMed
64.Li, F., Correa, P., & Graumeni, J. Testing for germ line p 53 mutations in cancer families. Cancer Epidemiology, Biomarkers & Prevention, 1991, 9194.Google Scholar
65.Loehlin, J., Willerman, L., & Horn, J.Human behavior genetics. Annual Review of Psychology, 1988, 39, 101–33.CrossRefGoogle ScholarPubMed
66.Managed Health Care Congress. Safe and Effective.Executive Seminar, Workshop Series S–7, Washington DC., 03 29–04 1, 1992.Google Scholar
67.Marx, J.Test could yield improved colon cancer detection. Science, 1992, 256, 32.CrossRefGoogle ScholarPubMed
68.Marx, J.Familial Alzheimer’s linked to chromosome 14 gene. Science, 1992, 258, 550.CrossRefGoogle ScholarPubMed
69.McCabe, E. The impact of genetic diagnosis and information in the practice of pediatrics. In Wilkinson, S. & Perry, S. (eds.), Biotechnology, the diagnosis of genetic diseases—final report. Washington, DC: Georgetown University. 1991.Google Scholar
70.McKusick, V.The Human Genome Project and clinical medicine. Hospital Practice, 1991, 26, 1516.CrossRefGoogle ScholarPubMed
71.McKusick, V.Genome mapping and how it has progressed. Hospital Practice, 1991, 26, 7490.CrossRefGoogle ScholarPubMed
72.McMahon, L.A critique of the Harvard resource-based relative value scale. American Journal of Public Health, 1990, 80, 793–98.CrossRefGoogle ScholarPubMed
73.Motulsky, A.Nutrition and genetic susceptibility to common diseases. American Journal of Clinical Nutrition, 1992, 55, 1244S–5S.CrossRefGoogle ScholarPubMed
74.Murray, T. H. Ethical issues in human genome research. FASEB Journal, 1991, 5560.CrossRefGoogle Scholar
75.Newcomer, L. N.Defining experimental therapy—A third-party payer's dilemma. New England Journal of Medicine, 1990, 323, 1702–04.CrossRefGoogle ScholarPubMed
76.Nichols, E.Human gene therapy. Cambridge, MA: Harvard University Press, 1988.Google Scholar
77.Osmundsen, J. New theory says gene clusters lay basis for inherited conduct. New York Times, 08 13, 1965, 26.Google Scholar
78.Plomin, R., & Rende, R.Human behavioral genetics. Annual Review of Psychology, 1991, 42, 161–90.CrossRefGoogle ScholarPubMed
79.Schellenberg, G., Thomas, D., Bird, E. et al. , Genetic linkage evidence for a familial Alzheimer's disease locus on chromosome 14. Science, 258, 1992, 668–71.CrossRefGoogle ScholarPubMed
80.Scriver, C. R., Neal, J. L., Saginur, R., & Clow, A.The frequency of genetic disease and congenital malformation among patients in a pediatric hospital. Canadian Medical Association Journal, 1973, 108, 1111.Google Scholar
81.Shapiro, R.The human blueprint: The race to unlock the secrets of our genetic script. New York, NY: St. Martin's Press, 1992.Google Scholar
82.Sharp, M.The management and coordination of biotechnology in the U.K. 1980–1988. Philosophical Transactions of the Royal Society of London, 1989, 324, 509–23.Google Scholar
83.Shirasawa, S., Furuse, M., Yokoyama, N., & Sasazuki, T.Altered growth of human colon cancer cell lines. Science, 1993, 260, 8587.CrossRefGoogle ScholarPubMed
84.Siddique, T., Figlewicz, D. A., Pericak-Vance, M. A. et al. , Linkage of a gene causing familial amyotrophic lateral sclerosis to chromosome 21 and evidence of genetic-locus heterogeneity. New England Journal of Medicine, 1991, 324, 1381–84.CrossRefGoogle ScholarPubMed
85.Sidransky, D., Tokino, T., Hamilton, S. et al. , Identification of ras oncogene mutations in the stool of patients with curable colorectal tumors. Science, 1992, 256, 102–04.CrossRefGoogle ScholarPubMed
86.Stein, C. A., & Cheng, Y.-C.Antisense oligonucleotides as therapeutic agents — Is the bullet really magical? Science, 1993, 261, 1004–12.CrossRefGoogle ScholarPubMed
87.Suzuki, D., & Knudtson, P.Genetics: The clash between the new genetics and human values. Cambridge, MA: Harvard University Press, 1989.Google Scholar
88.Swint, M. Economic considerations in the allocation of resources to genetic medicine. In Kaback, M. & Shapiro, L. (eds.) Frontiers in genetic medicine. Report of the 92nd Ross Pediatric Research Conference. Columbus, OH: Ross Laboratories, 1987.Google Scholar
89.Teitelman, R.Gene dreams: Wall Street, academia and the rise of biotechnology. New York, NY: Basic Books, 1989.Google Scholar
90.Thompson, M. W., Mclnnes, R. R., & Willard, H. F.Genetics in medicine, 5th ed.Philadelphia, PA: W. B. Saunders Co., 1992.Google Scholar
91.Vionnet, N., Stoffel, M., Takeda, J. et al. , Nonsense mutation in the glucokinase gene causes early-onset non-insulin-dependent diabetes mellitus. Nature, 1992, 356, 721–22.CrossRefGoogle ScholarPubMed
92.Vollrath, D., Foote, S., Hilton, A. et al. , The human y chromosome: A 43-interval map based on naturally occurring deletions. Science, 1992, 258, 5269.CrossRefGoogle ScholarPubMed
93.Waldholz, M. New test helps in the diagnosis of colon cancer: Researchers develop a new test used to detect cancer of the colon. Wall Street Journal, 04 3, 1992, B1, B10.Google Scholar
94.Weatherall, D. J.The new genetics and clinical practice. New York, NY: Oxford University Press, 1991.Google Scholar
95.Wexler, N.Disease gene identification: Ethical considerations. Hospital Practice, 1991, 26, 145–56.CrossRefGoogle ScholarPubMed
96.Young, E. W. D.Alpha and omega: Ethics at the frontiers of life and death. Menlo Park, CA: Addison-Wesley, 1989.Google Scholar