Cost-effectiveness of one-time genetic testing to minimize lifetime adverse drug reactions

Abstract

We evaluated the cost-effectiveness of one-time pharmacogenomic testing for preventing adverse drug reactions (ADRs) over a patient's lifetime. We developed a Markov-based Monte Carlo microsimulation model to represent the ADR events in the lifetime of each patient. The base-case considered a 40-year-old patient. We measured health outcomes in life years (LYs) and quality-adjusted LYs (QALYs) and estimated costs using 2013 US$. In the base-case, one-time genetic testing had an incremental cost-effectiveness ratio (ICER) of $43,165 (95% confidence interval (CI) is ($42,769,$43,561)) per additional LY and $53,680 per additional QALY (95% CI is ($53,182,$54,179)), hence under the base-case one-time genetic testing is cost-effective. The ICER values were most sensitive to the average probability of death due to ADR, reduction in ADR rate due to genetic testing, mean ADR rate and cost of genetic testing.

Pharmacogenomics of Antidepressant and Antipsychotic Treatment: How Far Have We Got and Where Are We Going?

“…With respect to psychiatry, the HLA markers described above are relevant for mood stabilizers carbamazepine and oxcarbamazepine. While genotyping to avoid life-threatening adverse drug reactions is mandatory for the HLA markers, pharmacoeconomic analyses provide support for the costeffectiveness of other pharmacogenetic-based treatment decisions, especially in the case of CYP2D6 (66,67). Currently, it seems evident that, out of many proposed markers, only genetic variants located in the CYP2C19 and CYP2D6 genes are of value for optimizing antipsychotic and antidepressant drug treatment.…”

Development of the PGx‐Passport: A Panel of Actionable Germline Genetic Variants for Pre‐Emptive Pharmacogenetic Testing

“…Several promising studies indicate the (cost‐)effectiveness of PGx panel‐based testing on healthcare utilization in psychiatry and polypharmacy, where observed cost savings ranged from $218 to $2,778 per patient. Others have modeled the cost‐effectiveness of one‐time genetic testing to minimize a lifetime of adverse drug reactions, and concluded an incremental cost‐effectiveness ratio of $43,165 per additional life year and $53,680 per additional quality‐adjusted life year, and, therefore, cost‐effective . However, cost‐effectiveness may vary across ethnic populations as a result of varying in allele frequencies, the target population as a result of varying prescription patterns, and the healthcare setting as a result of varying healthcare costs and incremental cost‐effectiveness ratio thresholds.…”

Genome-wide study identifies association between HLA-B*55:01 and penicillin allergy

“…In Europe, ADRs are responsible for 3.5% of all hospital admissions, with 10.1% of patients experiencing ADRs during hospitalization and 197,000 fatal cases per year 2,3 . In the US, the cost of a single ADR event falls between 1,439 to 13,462 USD 4 .…”