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Children (Basel). 2017 May 22;4(5). pii: E42. doi: 10.3390/children4050042.

Genetic Testing among Children in a Complex Care Program.

Oei K1,2, Hayeems RZ3,4, Ungar WJ5,6, Cohn RD7,8, Cohen E9,10,11,12.

Author information

1
Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada. krista.oei@mail.utoronto.ca.
2
Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. krista.oei@mail.utoronto.ca.
3
Child Health Evaluative Studies, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. robin.hayeems@sickkids.ca.
4
Institute of Health Policy and Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada. robin.hayeems@sickkids.ca.
5
Child Health Evaluative Studies, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. wendy.ungar@sickkids.ca.
6
Institute of Health Policy and Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada. wendy.ungar@sickkids.ca.
7
Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada. ronald.cohn@sickkids.ca.
8
Program in Genetics and Genomic Biology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. ronald.cohn@sickkids.ca.
9
Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. eyal.cohen@sickkids.ca.
10
Child Health Evaluative Studies, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. eyal.cohen@sickkids.ca.
11
Institute of Health Policy and Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada. eyal.cohen@sickkids.ca.
12
Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada. eyal.cohen@sickkids.ca.

Abstract

Little is known about the pattern of genetic testing and frequency of genetic diagnoses among children enrolled in structured complex care programs (CCPs). Such information may inform the suitability of emerging genome diagnostics for this population. The objectives were to describe the proportion of children with undiagnosed genetic conditions despite genetic testing and measure the testing period, types and costs of genetic tests used. A retrospective analysis of 420 children enrolled in Toronto's Hospital for Sick Children's CCP from January 2010 until June 2014 was conducted. Among those who underwent genetic testing (n = 319; 76%), a random sample of 20% (n = 63) was further analyzed. A genetic diagnosis was confirmed in 48% of those who underwent testing. Those with no genetic diagnosis underwent significantly more genetic tests than those with a confirmed genetic diagnosis [median interquartile range (IQR): six tests (4-9) vs. three tests (2-4), p = 0.002], more sequence-level tests and a longer, more expensive testing period than those with a genetic diagnosis [median (IQR): length of testing period: 4.12 years (1.73-8.42) vs. 0.35 years (0.12-3.04), p < 0.001; genetic testing costs C$8496 ($4399-$12,480) vs. C$2614 ($1605-$4080), p < 0.001]. A genetic diagnosis was not established for 52% of children. Integrating genome-wide sequencing into clinical care may improve diagnostic efficiency and yield in this population.

KEYWORDS:

children with medical complexity; complex care; genetic testing; health care utilization

Conflict of interest statement

The authors declare no conflict of interest. Funding for this project was provided through the Social Paediatrics Research Summer Studentship (SPReSS) program at the Hospital for Sick Children. The funders were not involved in the design or conduct of the study or preparation, review or approval of the manuscript. The authors have indicated they have no financial relationships relevant to this article to disclose.

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