Consecutive medical exome analysis at a tertiary center: Diagnostic and health‐economic outcomes

• Published in: American journal of medical genetics. Part A Vol. 182; no. 7; pp. 1601 - 1607
• Main Authors: Kosaki, Rika, Kubota, Masaya, Uehara, Tomoko, Suzuki, Hisato, Takenouchi, Toshiki, Kosaki, Kenjiro
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2020; Wiley Subscription Services, Inc
• Subjects: Abnormalities, Multiple - diagnosis; Abnormalities, Multiple - genetics; Bioinformatics; Brain - diagnostic imaging; Child, Preschool; Cohort Studies; Computational Biology; cost analysis; Cost-Benefit Analysis; Diagnosis; Genetic Diseases, Inborn - diagnosis; Genetic Diseases, Inborn - economics; Genetic Diseases, Inborn - genetics; Genetic disorders; Genetic screening; Genetic Testing - economics; Genetic Testing - methods; Genomes; Humans; Infant; Japan; Magnetic Resonance Imaging; medical exome analysis; outcomes; Patients; Tertiary Care Centers; Whole Exome Sequencing - economics; Whole Exome Sequencing - methods; Japan; cost analysis; medical exome analysis; outcomes
• ISSN: 1552-4825; 1552-4833
• DOI: 10.1002/ajmg.a.61589

The utility of whole exome analysis has been extensively demonstrated in research settings, but its clinical utility as a first‐tier genetic test has not been well documented from diagnostic and health economic standpoints in real‐life clinical settings. We performed medical exome analyses focusing on a clinically interpretable portion of the genome (4,813 genes) as a first‐tier genetic test for 360 consecutive patients visiting a genetics clinic at a tertiary children's hospital in Japan, over a 3‐year period. Bioinformatics analyses were conducted using standard software. A molecular diagnosis was made in 171 patients involving a total of 107 causative genes. Among these 107 causative genes, 57 genes were classified as genes with potential organ‐specific interventions and management strategies. Clinically relevant results were obtained in 26% of the total cohort and 54% of the patients with a definitive molecular diagnosis. Performing the medical exome analysis at the time of the initial visit to the tertiary center, rather than after visits to pertinent specialists, brain MRI examination, and G‐banded chromosome testing, would have reduced the financial cost by 197 euros according to retrospective calculation under multiple assumption. The present study demonstrated a high diagnostic yield (47.5%) for singleton medical exome analysis as a first‐tier test in a real‐life setting. Medical exome analysis yielded clinically relevant information in a quarter of the total patient cohort. The application of genomic testing during the initial visit to a tertiary medical center could be a rational approach to the diagnosis of patients with suspected genetic disorders.