UCSF Launches Center to Focus on Genomic Medicine

The University of California at San Francisco is making a significant investment in the development of new forms of genomic laboratory testing, with an initial focus on brain infections and how they can be more quickly diagnosed in a clinical setting.

Such diagnoses can save health care providers enormous amounts of money by avoiding long-term intensive care for many patients suffering meningitis and encephalitis, researchers say.

The opening of the UCSF Center for Next-Gen Precision Medicine Diagnostics was announced over the summer. It's been funded with $2.4 million in private foundation grants and $1.2 million from the public-private California Initiative to Advance Precision Medicine.

The clinical/research portion of the center is being headed by Joseph DeRisi, the UCSF chair of biochemistry and biophysics, Charles Chiu, M.D., and Michael Wilson, M.D. The latter two published a high-profile study in the New England Journal of Medicine last year about genomic techniques they have developed to identify rare forms of encephalitis. Last year, they were able to identify within a couple of days one form of the infection that struck a Wisconsin teenager. He had initially been misdiagnosed with an autoimmune form of encephalitis, leading to the use of corticosteroids for treatment. That caused his brain to swell, forcing doctors to place him in a medically induced coma. UCSF researchers were able to diagnose a relatively rare Caribbean variant of the disease in about 90 minutes. He was treated with penicillin and recovered.

"From a health outcomes standpoint, encephalitis and meningitis are very serious diseases," said DeRisi. Along with a mortality rate of around 6 percent, such infections often lead to weeks-long stays in hospital intensive care units and patients suffer serious permanent cognitive damage, requiring even more care.

Although there has been extensive research on vaccine development regarding brain infections, there has been less regarding their economic costs. However, the Centers for Disease Control and Prevention released a report last year tallying the economic costs for those stricken by the mosquito-borne West Nile Virus, which rarely leads to symptoms but can cause encephalitis or meningitis in some patients. The tally: An average $25,117 for each patient hospitalized, and another $22,628 per average for related medical costs over the next five years.

Pinpointing the cause of the brain inflammation as quickly as possible is the key to driving treatment. But about half of encephalitis and meningitis cases are never specifically diagnosed, leading to guessing games that in the case of the Wisconsin boy almost killed him.

"When people present with the meningitis encephalitis symptoms, what you want to do with any sort of diagnostic tests, hopefully you can change the choice of care they're receiving," said Brent Fulton, associate director of UC Berkeley's Global Center for Health Economics and Policy Research. Fulton will be conducting research to quantify the cost of deploying genomic tests for brain infections and their overall outcomes. Fulton will be poring over brain infection claims data, as well as the costs for outpatient treatments and drugs. In many instances, Fulton suggested that the costs of side-effects from certain treatments and long-term care may well outstrip the actual costs of treating a patient in the hospital.

Other potential hurdles to deploying genomic tests for brain infections will also be examined by Fulton. "When you look at prescription drugs, if they're approved by the Food and Drug Administration, Medicare covers them automatically," Fulton said. Not so with genomic tests and the laboratory companies that have developed them. The latter often have to engage in dialogue for months, if not years, with Medicare fiscal intermediaries to obtain codes that guarantee their coverage by Medicare. That does not even include separate dialogues for coverage by private payers.

Takeaway: The UCSF Center for Next-Gen Precision Medicine Diagnostics will use genomic testing to try to alter the economics of treating brain infections.