General considerations for integrating pharmacogenomics into mainstream medical practice

The first important issue is the choice of the genotyping platform, which is directly dependent on the cost of the pharmacogenomic test that is being offered. Despite the fact that there are numerous mutation detection and screening methods, there is no single platform or methodology that prevails for pharmacogenetic testing. Genotyping can be done using different approaches with respect to the throughput, amplification-based and separation technologies and labelling. The variety of detection approaches makes it not only difficult, but also challenging to determine which is better suited to a laboratory setting, although DNA sequencing is considered to be the gold standard for the identification of DNA sequence variants, particularly with the advent of the next-generation sequencing technologies. The initial investment costs and the expected test volumes are some of the factors that need to be taken into consideration prior to choosing the genotyping technique, including hardware and software, testing reagents, and kits. The choice of genotyping platform goes hand in hand with the training of the personnel -- not only of those performing, but also those interpreting the pharmacogenomic test. The continuing education of personnel in the diagnostic laboratory is crucial for the accuracy of the results obtained (see also below).Alongside this, and closely related to it, healthcare costs represent an important parameter. Generally, the cheaper the pharmacogenomic test, the more likely it is to be undertaken by a patient or prescribed by the physician. Unfortunately, economic barriers to the adoption of genomic data for individualising medical practice exist and mostly depend on the nature of the technology used. Different reimbursement policies from different insurance companies can also pose an obstacle to the rapid dissemination of pharmacogenomics. In other words, it is only when insurance companies start paying for pharmacogenomic tests to individualise drug prescri