Economic evaluation of the use of a pharmacogenetic diagnostic test in schizophrenia

Rejon‐Parrilla, Juan Carlos; Nuijten, Mark; Redekop, W.K.; Gaultney, J

doi:10.1016/j.hlpt.2014.08.004

Cited by 7 publications

(9 citation statements)

References 37 publications

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“…There is little research assessing the economic evaluation of the costs and outcomes of the use of pharmacogenetic tests in schizophrenia. We located one recent evaluation of the potential use of a pharmacogenetic test assessing CYP450 polymorphisms prior to treatment with risperidone (Rejon-Parrilla 2014). In this study, pharmacogenetic testing prior to risperidone treatment was used to guide dosing and was compared with the usual ‘trial and error’ dosing scheme.…”

Section: Obstacles To Personalised Medicine and Pharmacogenetic Testimentioning

confidence: 99%

Personalised approaches to pharmacotherapy for schizophrenia

Lally

MacCabe

2016

BJPsych advances

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SummaryThe traditional approach to selecting antipsychotic medication involves little more than trial and error. Recent advances in genetics and molecular science offer the hope of a ‘personalised medicine’ approach to antipsychotic development and prescribing in schizophrenia. Personalised medicine is the practice of tailoring medical treatment to the individual characteristics of each patient. In schizophrenia, this will involve the identification of more homogeneous subsets of patients through the application of genetics, epigenetics, proteomics and metabolomics, neuroimaging and other biomarkers, and the use of these findings to stratify patients according to their response to treatment. In this article, we focus on the emerging evidence in pharmacogenetics and biomarkers for assessing individual response and tolerability of antipsychotic medication in schizophrenia.

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Section: Obstacles To Personalised Medicine and Pharmacogenetic Testimentioning

confidence: 99%

Personalised approaches to pharmacotherapy for schizophrenia

Lally

MacCabe

2016

BJPsych advances

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“…The QHES checklist can generate a score between 0 and 100, while a score of 75 and more is of the highest quality [40] (Supplemental Table 1). Three reviewers assessed the quality of all included studies [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] independently, when results differed (N = 3) though, the consensus was reached through discussion by all authors.…”

Section: Quality Of Reporting Assessmentmentioning

confidence: 99%

Economic evaluation in psychiatric pharmacogenomics: a systematic review

et al. 2021

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Nowadays, many relevant drug-gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were costeffective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug-gene associations and for combinatorial PGx panels, but evidence is limited for many other drug-gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.

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“…In terms of interventions assessed, most included studies compared the costeffectiveness of different antipsychotics versus each other, placebo or nothing (57/73, 78.1%). The remaining studies assessed the cost-effectiveness of different coverage of Medicare drug plans (1/53, 1.6%) [19], electroconvulsive therapy (ECT) versus antipsychotic (1/53, 1.6%) [20], precision medicine test versus no test (4/73, 5.5%) [21][22][23][24], different monitoring schedules for patients receiving clozapine (1/73, 1.4%) [25], antipsychotics versus antipsychotics plus psychosocial interventions (5/73, 6.8%) [26][27][28][29][30], CBT versus no CBT (1/73, 1.4%) [17], improving patients' access to psychological therapies versus no intervention (1/73, 1.4%) [18], supported employment programme vs no intervention (1/73, 1.4%) [1], and different modes of liaison between primary and secondary care services (1/53, 1.6%) [15]. The availability of economic evidence across the schizophrenia care pathway is presented in Fig.…”

Section: Study Descriptionsmentioning

confidence: 99%

“…• a stratified test with 100% accuracy to inform the starting dose of risperidone for patients with first episode psychosis (FEP), compared to no stratified test [22];…”

Section: Conclusion For Non-pharmacological Interventionsmentioning

confidence: 99%

A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

et al. 2020

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Background: Schizophrenia is associated with a high economic burden. Economic models can help to inform resource allocation decisions to maximise benefits to patients.Objectives: This systematic review aims to assess the availability, quality and consistency of conclusions of health economic models evaluating the cost-effectiveness of interventions for schizophrenia. Methods: An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of interventions for schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Model characteristics and conclusions were descriptively summarised. Results: Seventy-three models met inclusion criteria. 78% of existing models assessed antipsychotics, however, due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly costeffective compared with the others. A very limited number of models suggest that the following nonpharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care. The quality of included models is generally low due to use of a short time horizon, omission of adverse events of interventions, poor data quality and potential conflicts of interest.Conclusions: This review highlights a lack of models for non-pharmacological interventions, and limitations of the existing models, including low quality and inconsistency in conclusions. Recommendations on future modelling approaches for schizophrenia are provided. Key Points for Decision Makers• This is the first systematic review of model-based economic analyses which covers the entire schizophrenia care pathway, by including any intervention for the prevention, detection, diagnosis, treatment and follow-up of schizophrenia.• This review highlights a lack of models for non-pharmacological interventions, and low quality of existing models. Common reasons for low-quality include use of a time-horizon which is not sufficiently long, failure to capture the health and cost impact of adverse events of the interventions under assessment, and potential conflicts of interest.• Due to inconsistent conclusions reported by different studies, no antipsychotic can be considered clearly cost-effective compared with the others. A very limited number of models suggest that the following non-pharmacological interventions might be cost-effective: psychosocial interventions, stratified tests, employment intervention and intensive intervention to improve liaison between primary and secondary care.• A consistent basis for the model structure, use of evidence and assumptions in health economic models is required in order to i...

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Economic evaluation of the use of a pharmacogenetic diagnostic test in schizophrenia

Cited by 7 publications

References 37 publications

Personalised approaches to pharmacotherapy for schizophrenia

Personalised approaches to pharmacotherapy for schizophrenia

Economic evaluation in psychiatric pharmacogenomics: a systematic review

A Systematic Review of Economic Models Across the Entire Schizophrenia Pathway

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