The clinical labs have much to learn about genetic web sites such as 23andme and ancestry.com (see: FDA Cracks Down on Consumer-Oriented Genetic Testing Web Sites; 23andMe Builds Online Sarcoma Research Community). This latter company is extending their genealogy business model into genetic testing.
I was trying recently to better understand the pricing options offered by 23andme and sent a query to their help desk about this topic. I got the following explanation back from the company. It provides some useful insights about the company and its future direction:
The 23andMe Personal Genome Service is a genotyping analysis of about one million SNPs resulting in interpreted data for both your genetic ancestry as well as your genetic disease risks and traits. There are three pricing options available to suit your individual budget:
- $99 upfront plus $9 per month subscription with a 12 month commitment. Your credit card is kept on file within your account and the subscription will automatically revert to a month-to-month billing after the 12 months are completed. If you wish to cancel after the 12 months, you must notify us by sending an email to firstname.lastname@example.org
- $207 - this is $99 plus the 12 month commitment paid in full (12 x $9 = $108). No credit card is kept on file. After your 12 months, you may continue your subscription, if you wish, by adding a credit card to your account for future billing.
- $399 - this is a one-time, flat fee which will cover all ongoing updates applicable to the current genotyping platform*. No credit card is kept on file. No subscription service or fees.
*The $399 price will cover all ongoing updates applicable to the current genotyping platform. So when you hear or read about "lifetime" what that means is the lifetime of the genotyping platform, not your lifetime.
Here are a few of my observations derived from this reply including some ideas about future directions for hospital-based clinical labs:
- Note first that the company is testing for "about one million SNPs" but seems to be preparing to shift at some future time to whole genome scanning as its "genotyping platform." Hence the clarification that the $399 fee only covers "all ongoing updates applicable to the current genotyping platform." Whole genome scanning will undoubtedly be more expensive than the current SNP analysis and the company does not want customers "grandfathered" automatically to this new platform.
- Secondly, the business model of the company covers testing of the current specimen and also a subscription to the web site. Customers obtain interpreted data about their genetic ancestry at the site as well as information about personal genetic disease risks and traits. The relationship with customers is thus maintained beyond the initial testing phase.
- Thirdly, the benefit to clients increases as the size of the company's proprietary genetic database increases. Also and because of economies of scale, the cost of SNP testing, and, ultimately, whole genome scanning, can only decrease over time. This, of course, makes the service more attractive to potential clients in the future.
- I envision the following lessons for hospital-based labs based on these observations: (1) the need to shift, in part, from the current physician-centric model to more of a patient-centric model; (2) hospital patients could also be shifted to a subscriber model such that they, or their treating physician, could be informed about new medical discoveries or treatments relating to their disease status and genetic profile; and (3) all of these changes will require functionality far beyond those provided by our current LIS capabilities (see: The -Omics Cloud: A Healthcare IT Solution Already Developed for Genomics Research).