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Mapping the Landscape of Genetic Tests for Non-Cancer Diseases/Conditions

Disposition of Comments

Project ID: GEND0508


The Agency for Healthcare Research and Quality's (AHRQ) Technology Assessment (TA) Program supports and is committed to the transparency of its review process. Therefore, invited peer review comments and public review comments are publicly posted on the TA Program Web site at http://www.ahrq.gov/clinic/techix.htm within 3 months after the associated final report is posted on this Web site.

This document presents the peer review comments and public review comments sent in response to the draft report, Update on Mapping the Landscape of Genetic Tests for Non-Cancer Diseases/Conditions, posted on the AHRQ Web site from December 22, 2010, through January 10, 2011. The final version of the report is available online.

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Contents

Select for Table 1: Invited Peer Reviewer Comments.

Select for Table 2: Public Review Comments

Table 1: Invited Peer Reviewer Comments

Reviewer1 Section2 Reviewer Comments Author Response3
1 General The goals of this report are admirable but extremely challenging to achieve. With at least 3000 genetic and genomic tests available on a clinical basis and no comprehensive central repository (although it is hoped that the Genetic Test Registry will ultimately fill this void), identifying all currently available tests applicable to the Medicare population is a cumbersome and manual process. Given an annual increase of at least 25% in the availability of genetic and genomic tests, I find it difficult to believe that there are just 105 total genetic and genomic tests applicable to the Medicare population, suggesting that a comprehensive list has not been compiled through this effort.

We agree that there are many available genetic tests and there is an exponential increase each year. Many of these tests do not make it to clinical use. For the same reasons, we have a set of eligibility criteria while reviewing genetic test yield. When we review these tests against our eligibility criteria (on page 4) this results in a smaller number of genetic tests that are applicable to the Medicare population.

In addition to providing a broad overview with sufficient information on each identified genetic test, our report provides a preliminary estimate of publications relevant to an eligible genetic test. The accompanying database serves as a ready reference for decisions on future topics for systematic reviews.  
Methods Although it is hoped that the Genetic Test Registry will become a comprehensive central repository for genetic and genomic tests, it has only been in existence for a few months and is voluntary in nature. Therefore, it is unlikely to be the most useful resource at this time. I would suggest that the GeneTests.org Web site remains a better resource for tests for inherited genetic disorders at this time. However, many other Web sites such as those identified in the report would need to be searched, particularly for pharmacogenetic tests. Thank you, we will cite the GeneTests.org Web site.
It is not clear from the Methods section how the search of the identified Web sites was approached. I would suggest a reasonable starting point might have been a literature search for adult onset genetic conditions. For example, a PubMed search conducted on April 12, 2012 using the search terms (genetic OR inherited) AND (predictive OR presymptomatic OR prognostic OR diagnostic OR preventive OR prevention) AND (adult or adult-onset) and limited to published in the last two years, English language, human and review articles yielded 496 citations. Review of such literature search results would likely generate a reasonable starting list to then use in searching the identified Web sites and may provide more comprehensive results. The purpose of this report is to identify tests that are already in clinical practice. Similar approaches to identifying tests from querying PubMed were applied as early as 2006 report on cancer, but were not found to be an optimal way to identify genetic tests that are in clinical use. The majority of the tests obtained through a PubMed search yield were relevant to identify tests that were in research development.
Results As stated above, I do not believe that all genetic and genomic tests relevant to the Medicare population have been identified by this analysis. The objective of this report was to provide a broad overview with sufficient information on each identified genetic test and a preliminary estimate of publications relevant to an eligible genetic test. The accompanying database serves as a ready reference for decisions on future topics for systematic reviews. While we strive to identify as many tests as possible, identifying  all genomic tests relevant to the Medicare population cannot be achieved because of limitations (on page 16)
Discussion/ Conclusion Limitations of the study are appropriately noted but perhaps greater emphasis on the dynamic nature of genetic/genomic testing for non-cancer applications is needed as well as the difficulties of generating a comprehensive list of tests. A definite schedule for updating both the existing information sheets and the addition of new tests is needed. At a minimum a comprehensive scan should be performed annually.

Thank you, we will add the suggested limitations to our report.

Please refer to page 8 with regard to a definite schedule for updating the information sheets. While the noncancer reports are published biennially, the information sheets within the database are updated monthly.

Appendices

Suggestions for the test information sheets:

  • Expand description of test; define terms used
  • Provide a date for the literature search
  • Include a few key abstracts or at least links to key citations
  • Write sources in proper citation style; include links to Web sites, if used
Currently the database generates automatic queries and lists the number of citations available. It will not be possible to include key abstracts without knowing what the key questions of interests are. The database does not allow hyperlinks to Web sites, but does allow delinked Web site addresses.
References This reference list seems very short—I assume more resources were used? If so, they should be cited. Dates of access of Web sites should be included. We have added few additional citations. This is a short concise report and most of the resources to obtain genomic tests were from Web sites.
2 General This report was last updated in 2010 and the last full report on genetic tests for non-cancer diseases/conditions was published in 2007. The authors maintain a more frequently updated database for internal use only. It seems that the current approach to assessing technologies in this rapidly evolving domain could use some renovation. In particular, the present seems to offer a good opportunity to harmonize the active surveillance conducted for this report with the passive surveillance proposed for the NIH Genetic Test Registry. Thank you for your suggestion.
Introduction/ Background

NOTE: page numbers in the following comments refer to the PDF file, not to internal document page numbers.

p. 5: Referring to the Human Genome Project and HapMap seems a little dated. Many developments since then are inspiring the development of genetic tests.

p. 5: The word "the" should not precede "genetic tests" when referring to genetic tests in general. For example, "The genetic tests can be used..." should be "Genetic tests can be used...." Multiple instances of this usage should be corrected. An editor skilled in English usage, grammar, and style should review the document.

Thank you, we have added a bit more information to the introduction.

Thank you, our final report has now been reviewed by an editor.
Methods

Terminologies, definitions, and eligibility criteria

p. 8: Clarify that tests were selected if they met any of the 3 criteria listed at the top of the page (e.g., by adding "or" to the end of the first 2).
p. 8: Consider deleting "primary or secondary" after prevention. This is a little confusing, since the goal of secondary prevention is detection and treatment of existing disease at an early stage.
p. 9: It should be noted that the Genetic Test Registry (GTR) is still in development and should not be considered a comprehensive resource at this time.
p. 10: Did the Google news alert used to identify new tests combine "gene OR genetic OR genomic test OR epigenetic OR proteomic" AND "FDA cleared or clearance."  What was the actual term used to search for FDA clearance? (It is not clear from this sentence.)
p. 9: Another potential grey literature source for new tests is the GAPPFinder (http://www.hugenavigator.net/GAPPKB/topicStartPage.do, search or click on "All" to display contents).   Although most of these tests are upstream (not in widespread use or cleared by FDA), this database is updated frequently and could supplement other sources. Additional information is available at http://www.hugenavigator.net/GAPPKB/GAPPDescription/aboutFinder.htm and in Genet Med. 2011 Feb;13(2):161-5.

p.8: Thank you, we have clarified by adding "or"
p 8: Done.
p.9: We have not mentioned GTR as a comprehensive source.
p.10. We have clarified our search strings using brackets
p. 9. We will screen available tests in GAPPFinder and include tests that are in clinical use and that meet our pre-specified eligibility criteria.

Updating of the database and Tracking the Evolution

p. 13: How does this work, and how does the knowledge base build? For example, it appears that one-page summaries in Appendix A are only for newly described tests (although some of these, like tests for familial cholesterolemia, are not really new). Will they appear in Appendix B in the next review? What will happen to the tests reviewed in 2007 and in the current Appendix B? Will they drop out next time?

Table 1 (web sites searched) could be placed in an Appendix.

Genetic database for tests that come up during grey literature searches are updated monthly and the evolution of tests are tracked annually. We will keep adding tests as they are identified and all tests in the database will be tracked for their evolution.

Thank you, we will move Table1 to the Appendix section.

Description of the Electronic Database
p. 15: The database is not accessible to report users, although it could provide a more comprehensive, updated picture of available tests. These could include tests introduced at different times for similar applications. Now seems like a good time to harmonize database development with the NIH Genetic Test Registry (GTR), especially since the database already interfaces with PubMed.

p. 15: Is there a difference between "FDA cleared" and "FDA approved"? If the same, use consistent terms; if different, please explain.

Thank you for your comments.

 

 

We will change the table header to "FDA cleared."
Results  p. 19: The report identifies 15 tests (17 test-disease combinations) as new since 2010. The GAPP Finder indexed 172 tests in 2011 and 12 so far in 2012, although many of these are in development and may not yet be available for clinical use. I'm confident that the tests included in the report are the most important clinical tests; nevertheless, it might be helpful to revisit the definition of "genetic test," as well as the inclusion and exclusion criteria, for future reports. For example, the definition on p. 7 actually dates from the 1997 Task Force on Genetic Testing report and has been propagated unchanged through many subsequent generations of government documents. If genetic tests were actually defined to include "gene products (e.g., enzymes, other types of proteins, and selected metabolites)" as well as "heritable or somatic mutations," the universe of so-called genetic tests would be vast indeed.

We agree that there are many available genetic tests and there is an exponential increase each year. When we reviewed these tests against our eligibility criteria (page 4) this resulted in a smaller number of genetic tests that are applicable to the Medicare population.

Yes, the definition on page 7 is our working definition for identifying genetic tests.

Discussion/ Conclusion

p. 20: The paragraph on limitations is helpful. The issues cited are common to all current attempts to survey this domain. The GAPP Finder aims to capture changes in test composition or trade name and although it can't be considered complete, it might be useful for cross-checking.

p. 20-21: The authors contrast their active approach to the passive reporting planned for NIH's GTR. Where is the plan to harmonize these activities? The authors of this report can't be expected to coordinate the activities of government agencies; however, it seems that there should be a plan that they can reference.

p.20: Thank you for your comments. We will use the GAPP Finder to cross-check genetic tests that are currently in clinical use, and we will cite the GAPP Finder Web site in the final draft.

p. 20-21: We agree that this is beyond the scope of the report. Plans to harmonize existing data gathering efforts on genetic tests are anticipated to occur through communication among various government agencies.

Appendices The appendices provide the essential content that will be used for reference until the next report is published. They present lots of useful data in a well-organized format. A few specific comments follow. Thank you for your comments.
Appendix A

p. 24: Clarify whether the list is of multiple genes, or gene aliases.
p. 28: What does "ND" stand for?
p.29: Clarify that Plavix is the trade name for clopidogrel. (The first sentence may contain a typo: "Description: Clopidogrel   Plavix, is an anti-platelet agent...")
p. 43: How should "evolution of tests" be interpreted? How does the knowledge base on these tests build? For example, it appears that one-page summaries are only for newly described tests (although some of these, like tests for familial cholesterolemia, are not really new). Will these be summarized in an "evolution of tests" table in the next review? What will happen to the tests reviewed in 2007? Will they drop off the list next time?

p.24: we have clarified.
p.28: ND has been expanded to not documented
p 29 Clarified.
P 43. As stated in the page 8, the purpose is to find if those tests are still available. We have not stated "dropping off the list next time" in our methods section.

Appendix B

Five tests have a "y" in the "FDA approved" column but the text (p. 19) states that "only three of the 90 tests have been cleared by the FDA."

See additional comments on the contents of this table under p. 13 (above).
We have corrected this typo as "5 tests for 3 disease conditions."
Appendix C p. 48: Drug names are centered on the "dermatology and dental" category, which takes 2 lines. This leads to unnecessary squinting. Since the drugs are already grouped and alphabetized by therapeutic category, column 2 could be eliminated and replaced by subheadings. We have reformatted the middle column. We realize that the disease conditions have been repetitive, but we cannot place subheadings because some of the disease conditions appear only once.
References Only minimal references are provided for the text. Appendix A includes source data for each test. In some cases this is a scientific publication; more often it is a company Web site (e.g., correlagen.com) that is not specific to the test being reviewed. Users who want to find more information about the test must search the company Web site or the Internet. The purpose of the report is to succinctly summarize information in one-pagers.
3 General This is an update on mapping the landscape of genetic tests for non-cancer diseases/conditions. To qualify, a given test must be in clinical practice and be applicable to a Medicare population. The scope is well defined, and exclusion and inclusion criteria are adhered to. It follows two earlier horizon scan reports on this subject from 2007 and 2010. A database accompanies the report that summarizes data obtained from each identified test provider's Web site for new tests that have been introduced since the 2010 horizon scan. Its purpose is to serve as a reference for decision-making on future topics for systematic reviews. The report is well organized and clearly written (a few suggestions are made below on minor points of clarity). Thank you.
Executive Summary There is no executive summary. The report is brief and none is needed. Thank you.
Introduction/ Background Satisfactory. No comment. Thank you.
Methods Grey literature sources were the primary focus of searches for this report. The eight sources (sites) described, supplemented by commercial Web sites, should yield a reasonable representation of relevant current activity. The one-page summaries prepared for each of the new tests are straightforward and should prove helpful in the selection of future topics for systematic review. Listing the number of citations is worthwhile as a preliminary indicator. The in-house developed electronic database is an important advantage. The numbers provided are from a preliminary search. We do conduct a fine tuned search when a particular topic is identified for focused review. Presenting a list of primary citations without screening will not be useful to the reader. Currently abstract screening without a set of specific key questions to address will not be useful.
Text comments page 3 Inclusion criteria, line 2 "adults Medicare age group"—missing word. Line 7 "We included tests that are performed to aid diagnosing, treating, predicting and prognosticating of adult patients"—needs re-writing. Page 4 Exclusion criteria, line 5 "prognosticating"—awkward language. Page 4, line 4 "predicting for outcome"— "for" should be removed. Page 6, line 2, "contents scope includes test' purpose" needs tidying up. Page 12, lines 6 and 12, the word "data" is plural. Line 19, "Upon logging in the password-protected site" should be "logging into", I believe (same on page 13). Page 13 line 4, "generate a number of hits" would better be "number of citations" (I usually think of hits as visits to a site). These typos and errors have been corrected. The document has been thoroughly reviewed by an editor.
Results This is brief and to the point. It reflects the work described in Methods. The one page summaries shown in Appendix 1 are integral to results. They fulfill the purpose of serving as a jumping off point for future decision-making. Thank you.
Discussion/ Conclusion The most important point made here is that the present approach to keeping abreast of new test information is superior to the NIH GTR and that this approach is worth the effort. Thank you.
  Text Comment page 16, 5th line from bottom, "made to a test, but retains" should be "but the test retains". Edited.
  Figures The one figure is difficult to read. This is a snap shot of the front-end of Gene Test Tracker database. We have expanded the scale to help visualizing the figure.
  Appendices Appendix A has already been discussed. The material is well presented and worthwhile. Appendices B & C are lengthy tables. They are not difficult to read. Thank you.
  References The four references listed appear to be adequate. Thank you.

1. Peer reviewers are not listed in alphabetical order.
2. If listed, page number, line number, or section refers to the draft report.
3. If listed, page number, line number, or section refers to the final report.

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Table 2: Public Review Comments

Reviewer1 Reviewer Affiliation2 Section3 Reviewer Comments Author Response4
Marijke Annis CardioDx Appendices

 Please review the following comments specific to Corus? CAD, the test described on page A-5 of the Appendix to ?Update on Mapping the Landscape of Genetic Tests for Non-Cancer Diseases/Conditions." Comments are provided for the specific sections listed on page A-5. Any sections not listed in the
comments below are accurate as written in the draft document.

The Test Name is Corus? CAD. The parenthetical phrase (coronary artery disease) should not be included in the test name.

The Description of Corus? CAD in the draft update should be revised to the following to ensure accurate representation of the test:

Description: Corus? CAD by CardioDx is a blood-based gene expression test that integrates the expression levels of 23 genes and other patient characteristics to assess whether an individual patient?s symptoms may be due to obstructive coronary artery disease (CAD). The patient?s blood sample is generally obtained in a primary care or cardiology clinic setting. Given that RNA levels are altered when obstructive CAD is present, the Corus CAD score aids clinicians in the diagnosis of obstructive coronary artery disease. Corus CAD is the first sex-specific test for CAD that accounts for key biological differences between men and women.

The Purpose of Corus? CAD in the draft update should be revised to the
following to ensure accurate representation of the test:

Purpose: Diagnosis

The Methodology of Corus? CAD in the draft update should be revised to the following to ensure accurate representation of the test:

Methodology: Quantitative real-time polymerase chain reaction (qRT-PCR)
 
The Clinical Uses of Corus? CAD in the draft update should be revised to the following ensure accurate representation of the test:

Clinical Uses: The test is intended to be used in an outpatient setting with non-diabetic, stable patients who present with typical or atypical symptoms suggestive of CAD, have no history of prior myocardial infarction (MI) or revascularization procedure, and are not currently taking steroids, immunosuppressive agents or chemotherapeutic agents.

The section entitled Medline Search for Corus CAD in the draft update should
be revised to include the following studies:

Wingrove JA, Daniels SE, Sehnert AJ, et al. Correlation of Peripheral-Blood Gene Expression With the Extent of Coronary Artery Stenosis. Circulation
Cardiovascular Genetics 2008;1;31-38.

Elashoff MR, Wingrove JA, Beineke P, et al. Development of a Blood-based Gene
Expression Algorithm for Assessment of Coronary Artery Disease in Non-Diabetic
Patients. BMC Medical Genomics 2011. 4:26; http//www.biomedcentral.com/1755-
8794/4/26.

Rosenberg S, Elashoff MR, Beineke P, et al. Multi-center Validation of the
Diagnostic Accuracy of a Blood-Based Gene Expression Test for Assessing
Obstructive Coronary Artery Disease in Non-diabetic Patients. Annals of
Internal Medicine 2010: 153:425-434.

Rosenberg S, Elashoff MR, Lieu HD, et al. Whole Blood Gene Expression Testing
for Coronary Artery Disease in Nondiabetic Patients: Major Adverse
Cardiovascular Events and Interventions in the PREDICT Trial. J Cardiovascular
Translational Research 2012 DOI 10.1007/s12265-012-9353-z [in press, e-

publication ahead of print]

Thank you, we have edited one-pager on Corus™ CAD as suggested.

Since the one-pager does not allow entry of citations, we have stated that there are 4 citations available at the manufacturer's Web site.

Wendy Bruening, Ph.D ECRI Institute General This report describes the construction of and content of a database of genetic tests. If it works as described, it will be a useful resource. Thank you.
I have some questions that I suspect most readers of the report would like  answers to within the report. -Are there plans in place to allow this database to be used by the general  public for free, much as Pubmed is available? or will it be restricted to  select users only? Or kept as an in-house resource only?  -Are there resources devoted to/ or plans to obtain such resources/ to keep  the database continually up to date and operating? Plans to harmonize existing data gathering efforts on genetic tests are anticipated to occur through communication among various government agencies. We anticipate that the database will be made public in the future.
Would it possible to include lists/ links to commercial laboratories offering  each individual test on each test's one-page summary? The current database does not allow storage of hyperlinks.
Minor points:  there is no such word as "prognosticating" , and the phrase "predicting and  prognosticating" is redundant and inaccurate. Is there really a need to invent and use a phrase like "mapping the landscape  of genetic tests"?  really? it's a database. say so. We have edited these phrases. We don't plan to change the title of the report as it reflects the task order.
p. 4 bottom: "we mostly adopted the previous" suggest saying: "we mostly adopted those used in previous" Edited.
p. 10 2/3 down: "the majority of the clinically available tests was identified" should be "were identified" Edited.

p. 10 bottom point 5. "the specimen was utilized" suggest saying "the specimen that was used"

Edited.
Mitchell Burken, MD MAC J12 CMD (Novitas Solutions, Inc.) General

I have some general awareness of testing for pre-renal transplantation using Mol Dx. I have not heard anything specific about this testing as a useful adjunct to conventional HLA, PRA, etc. testing. Here are two Web sites, which
might help your gray literature search.

http://www.invitrogen.com/site/us/en/home/Products-and- Services/Applications/Diagnostics-Clinical-Research/ Transplant-Diagnostics.html

http://www.seqwright.com/researchservices/ HLA_Genotyping.html? gclid=COTWssjvm6 8CFcJM4Aod-QMAbQ

Hopefully, this might be some type of useful lead for your final horizon scan.

Best, Mitchell Burken, MD (mitchell.burken@highmarkmedicareservices.com)
Thank you, these tests do not meet our eligibility criteria.
Cathy Fomous, PhD NIH Office of Biotechnology Activities General

I finally took a moment to look at the Update on Mapping the Landscape of Genetic Tests for Non-cancer Diseases/Conditions—an impressive effort. I wanted to suggest two edits regarding the Genetic Testing Registry (GTR). I'd greatly appreciate it, if you could pass them along to the appropriate person.

p. 5, last sentence: The GTR was launched in February 2012; please change the year in this sentence from 2011 to 2012. Also, "voluntary" better describes the submission, not the information, so the end of the sentence could be tweaked slightly. The NIH Genetic Testing Registry (GTR) is available since 2011 2012 as a central location for voluntary genetic test information voluntarily submitted by providers.

p. 16, last paragraph: similar edit as above. The NIH GTR, currently available to the public, relies solely on voluntary genetic test information voluntarily submitted by providers.
Thank you, we have incorporated your suggested edits.
Kathleen Gans-Brangs, PhD AstraZeneca Pharmaceuticals LP General The attached information is supplied in response to an open public comment  period. The AHRQ Technical Assessment document is an effort to assemble information on  genetic tests as delimited by a restrictive set of criteria.   While we  support the effort to collate such information, we have concerns about the  methodology used, the comprehensiveness of the data and the potentially biased  view of the data collected. We are concerned that this information does not  present a useful set of data for assessment of genetic tests and does not  provide information relevant to the quality of the test or the information  provided by a given test. We would like to clarify that this is not a comprehensive assessment of genetic tests. The goal is to identify genetic tests that are eligible to the Medicare populations through grey literature searches.
Methods The acceptance criteria for genetic tests are limited in order to focus this  report on a manageable number of tests. The authors use 'grey' literature searches to identify tests matching their criteria. This search method rarely provided peer-reviewed information concerning specific tests. References that were cited for specific tests seem to be obtained from the test provider as opposed to an independent search of the literature supporting the test. The authors state that this methodology is based on prior experience with literature searches suggesting the preferred method of grey literature sourcing used for this report. The rationale supporting their experience is unclear. The combination of corporate web sites, government web sites, and  academic web sites used are inconsistent in the vetting of their information  and are often considered biased sources of information. We searched the grey literature sources to identify genetic tests that are on the horizon. We have not found a correlation between the number of publications and a test becoming available to clinical use. This process is not the same as conducting a systematic review. While there are methodologies to assess risk of bias that evaluate conduct of a study, we are not aware of methodologies to evaluate risk of biases relating to evidence sources.
Results The one-page summaries of individual tests are potentially useful in terms of format, but we have concerns about the information provided. The Description section of each summary varies from only discussing the gene being tested to a summary of the associated monogenic disorder to potential clinical consequences associated with a therapeutic choice. Such information is not supported by independently-sourced peer-reviewed literature. Statements such as ?confirmed by several studies? are not helpful to the user of this  information without an independent method of assessing the strength of the  claim. As stated in our objectives (on page 2-3), detailed evaluations pertaining to clinical utility of a test will be the subject of future systematic reviews.
Appendices Appendix B is a list of genes identified in earlier versions of this report along with a column on FDA approval status and whether the test is still available at the time of the update. We have several concerns about how this information might be used. The disease listed next to each gene is often not the only use for the implied genetic test. A use of this approach could have just as easily resulted in the selection a different disease associated with a particular gene. By associating one gene with one disease we are concerned that incomplete information regarding a particular test would be presented to the report user. The FDA approval column does not indicate which test has been approved by the FDA. Many clinical laboratories use Laboratory Developed Tests that have not received FDA approval for exactly the same genes listed in Table 1 of Appendix B. The user of the table may be left with the incorrect understanding that the FDA has approved all tests for a particular gene. We recommend that the FDA approval column clearly reflect approval status.  

We do not list tests that are used solely for gene-disease association that are still in research development. Genomic tests in clinical use are listed to aid clinicians and patients to make informed decisions about their availability and appropriate use. Currently, genomic tests are not required to be cleared by FDA for their clinical use. We have made additional statements referring readers to the FDA Web site to get complete information about a test clearance status.

Appendix C  is a listing of genes appearing in the product labeling of  individual drugs listed. The majority of the genes listed are found in the  drug metabolism section of the prescribing information and not routinely  tested prior to prescription of the drug. Other genes listed are disease causing mutations or antiviral binding sites. Very few of the drugs in the table have language in the prescribing information requiring or even suggesting genetic testing of the genes listed. It is unclear how this information could be used by the reader. Appendix C represents a table available at the FDA Web site that lists genomic biomarker in drug labels. We did not cross-check if it is part of prescribing information.
Niru Anne, MD, FACS Our Lady of Lourdes Memorial Hospital General  It is very important to risk stratify patients and possibly prevent disease processes. I am a Surgical Oncologist and I do counsel patients on genetic testing when they are diagnosed with cancer. It is interesting to see this extrapolated to non-cancer conditions. Thank you.
Methods Is it possible to include other centers in the methods?  We have added a couple of resources based on reviewers' input.
Discussion/ Conclusion I would appreciate updates on this topic of risk stratifying based on genetics and the goal of prevention of disease. Thank you.
Anonymous Reviewer 1 NA General I find embarrassing the number of grammatical, syntactical and typographical errors contained in the report. Thank you, our final report has been reviewed by an editor.

1. Names are alphabetized by last name. Those who did not disclose name are labeled "Anonymous Reviewer 1," "Anonymous Reviewer 2," etc.
2. Affiliation is labeled "NA" for those who did not disclose affiliation.
3. If listed, page number, line number, or section refers to the draft report.
4. If listed, page number, line number, or section refers to the final report.

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Current as of November 2012


Internet Citation:

Mapping the Landscape of Genetic Tests for Non-Cancer Diseases/Conditions: Disposition of Comments. November 2012. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/ta/comments/gentests/index.html


 

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