Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

Verhoef, Talitha I.; Redekop, William K.; Langenskiöld, Sophie; Kamali, Farhad; Wadelius, Mia; Burnside, Girvan; Zee, Anke‐Hilse Maitland‐van der; Hughes, Dyfrig; Pirmohamed, Munir

doi:10.1038/tpj.2016.41

“…These results not only highlight which drug-gene pairs are likely to drive overall value in a panel-based or sequencing approach, but also indicate which specific singlegene testing strategies have favorable cost-effectiveness estimates. Notably, our finding that Clopidogrel and Warfarin are cost-effective single-gene testing scenarios is consistent with published studies on single-gene testing for those two drugs (Verhoef et al 2016;Kazi et al 2014).…”

Section: Value Of Genomic Informationsupporting

confidence: 92%

“…Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al 2016;Verhoef et al 2016;Kazi et al 2014).…”

mentioning

confidence: 99%

The Value of Pharmacogenomic Information

Graves¹,

Garbett²,

Zhou³

et al. 2019

Economic Dimensions of Personalized and Precision Medicine

2

0

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Pharmacogenomics, or the application of genetic testing to guide drug selection and/or dosing, is often cited as integral to the vision of how precision medicine can be integrated into routine clinical practice. Yet despite a growing base of scientific discovery on genetic variation that predicts drug response, reimbursement for genetic testing among health systems and payers remains uneven. In large measure this is because the cascading impacts of genetic testing on individual and provider incentives and behavior, as well as downstream health care spending and outcomes, remain poorly understood. In this study, we couple evidence from a real-world implementation of pharmacogenomic testing with a discrete event simulation model. We use this framework to evaluate the cost-effectiveness of various genetic testing strategies. We find that the cost-effectiveness of multiplexed genetic testing (e.g., whole genome sequencing) hinges on the ability of a health system to ensure that dense genotypic information is routinely utilized by physicians. Moreover, while much attention has been paid to lowering the cost of genetic tests, we demonstrate that in practice, other scientific and behavioral factors, focused on certain highyield drug-gene pairs, are key to implementing precision medicine in ways that maximize its value. John A. Graves

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“…Even when the results of randomize clinical trials are available, such as those on the impact of CYP2C9 and VKORC1 genotypes on warfarin dosage, conflicting outcomes from either side of the Atlantic do not provide consensus with regard to clinical implementation (13, 14). Nevertheless, continuing pharmacoeconomic assessment is beginning to offer more clarity (15). Any implementation of routine pharmacogenetic testing in selecting the doses of drugs metabolized by CYP2D6 has been even more protracted.…”

Section: Pharmacogeneticsmentioning

confidence: 99%

Personalized Drug Dosage – Closing the Loop

Tucker

¹

2016

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A brief account is given of various approaches to the individualization of drug dosage, including the use of pharmacodynamic markers, therapeutic monitoring of plasma drug concentrations, genotyping, computer-guided dosage using ‘dashboards’, and automatic closed-loop control of pharmacological action. The potential for linking the real patient to his or her ‘virtual twin’ through the application of physiologically-based pharmacokinetic modeling is also discussed.

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“…John A. Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al 2016;Verhoef et al 2016; Kazi et al 2014).…”

Section: Introductionmentioning

confidence: 99%

“…John A. Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al 2016;Verhoef et al 2016; Kazi et al 2014).Compared with single gene testing, these strategies-which include whole genome sequencing (WGS), whole exome sequencing (WES) and multiplexed genetic panel testing-facilitate the acquisition of wide swaths of genetic information all at once. Thus, a drug-gene pair for which single-gene testing is found to be cost-ineffective could potentially improve overall value when integrated within a broader multiplexed testing strategy, since information on that gene can are not better understood it will be difficult if not impossible to capture the potential value of pharmacogenomics in particular and precision medicine more broadly.…”

mentioning

confidence: 99%

The Value of Pharmacogenomic Information

Graves

¹

,

Garbett

²

,

Zhou

³

et al. 2017

View full text Add to dashboard Cite

Pharmacogenomics, or the application of genetic testing to guide drug selection and/or dosing, is often cited as integral to the vision of how precision medicine can be integrated into routine clinical practice. Yet despite a growing base of scientific discovery on genetic variation that predicts drug response, reimbursement for genetic testing among health systems and payers remains uneven. In large measure this is because the cascading impacts of genetic testing on individual and provider incentives and behavior, as well as downstream health care spending and outcomes, remain poorly understood. In this study, we couple evidence from a real-world implementation of pharmacogenomic testing with a discrete event simulation model. We use this framework to evaluate the cost-effectiveness of various genetic testing strategies. We find that the cost-effectiveness of multiplexed genetic testing (e.g., whole genome sequencing) hinges on the ability of a health system to ensure that dense genotypic information is routinely utilized by physicians. Moreover, while much attention has been paid to lowering the cost of genetic tests, we demonstrate that in practice, other scientific and behavioral factors, focused on certain highyield drug-gene pairs, are key to implementing precision medicine in ways that maximize its value. John A. Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al. 2016;Verhoef et al. 2016; Kazi et al. 2014).Compared with single gene testing, these strategies-which include whole genome sequencing (WGS), whole exome sequencing (WES) and multiplexed genetic panel testing-facilitate the acquisition of wide swaths of genetic information all at once. Thus, a drug-gene pair for which single-gene testing is found to be cost-ineffective could potentially improve overall value when integrated within a broader multiplexed testing strategy, since information on that gene can are not better understood it will be difficult if not impossible to capture the potential value of pharmacogenomics in particular and precision medicine more broadly.In this study, we couple evidence from a real-world implementation of pharmacogenomics with a discrete event simulation model for multiplexed genomic testing. In doing so, we build on theoretical insights to estimate both the value of pharmacogenomic information (i.e., the dollar-valued opportunity cost of not incorporating genomic information into therapeutic decision-making) and the cost-effectiveness of alternative genomic testing approaches. Notably, the scalability and flexibility of our simulation approach affords us the ability to conduct large-scale probabilistic sensitivity analyses (PSA) under which we re-estimate our model over a large (varying) parameter space. Coupled with novel methods in metamodeling and value of information (VOI) analysis, this allows us to identify key econo...

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Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

Cited by 34 publications

References 37 publications

The Value of Pharmacogenomic Information

The Value of Pharmacogenomic Information

Personalized Drug Dosage – Closing the Loop

The Value of Pharmacogenomic Information

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