DNP 810 Topic 6 DQ 1: genomics, services and cost

Separate the two halves before answering either. New demand means services that did not previously exist: genetic counselling capacity, variant interpretation, cascade testing for relatives, pharmacogenomic decision support inside prescribing systems, and surveillance programmes for people identified as high risk who are otherwise well. In an aging population that demand is amplified, because the conditions genomics most often speaks to — cancer, cardiovascular disease, dementia, polypharmacy — are concentrated in older adults, and because an older patient on eight medications is exactly the person a pharmacogenomic panel has most to say about. Older adults are also where the demand shows up in a second way that is easy to miss: cascade testing works upward and sideways through a family, so identifying a variant in an eighty-year-old generates testing requests from adult children and grandchildren, and the counselling capacity that requires is a service the system did not previously need to provide at all.

Expenditure is the harder half and the honest answer runs in both directions. Genomics adds cost through testing, counselling, the workforce to interpret results, and the downstream investigation of findings that turn out to be incidental. It removes cost by avoiding ineffective treatment, preventing adverse drug reactions that produce admissions, and concentrating expensive surveillance on the people who will benefit rather than on everyone. Which effect dominates depends on the specific application and on whether the health system captures the savings at all — a laboratory budget bears the testing cost while an avoided admission saves a different budget entirely, and that mismatch is why cost-effective genomics is often not adopted. Then give the one example the prompt asks for. Pharmacogenomic testing before prescribing in a polypharmacy clinic works well, because both the cost and the avoided harm are concrete and the aging population framing is built in.