Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Abstract

Background Schizophrenia is a severe mental disorder that often manifests within the first three decades of life. Its prognosis is uncertain and may result in a prolonged treatment that could extend throughout the entire lifespan of the patient. Antipsychotic drugs are characterized by a high interindividual variability when considering therapeutic effect and emergence of adverse effects. Such interindividual variability is thought to be associated primarily with pharmacokinetic matters. Objective The objective of this study was to evaluate the economic impact of the application of the 5-Step Precision Medicine model (5SPM), an approach based on the pharmacogenetic analysis of the primary genes involved in the metabolism of the therapy for each patient, restructuring treatment as necessary. Patients and Methods One hundred eighty-eight psychiatry patients were analysed for single nucleotide polymorphisms on genes CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5 and ABCB1. Information on patients’ diagnosis, pharmacotherapy, and hospitalizations was collected. Results We achieved a cost–benefit ratio of 3.31–3.59 with a reduction of direct cost (hospitalizations plus pharmacotherapy) with a reduction of total cost in 67% of the patients who underwent the clinical intervention. Conclusion A rational Precision Medicine-based approach to psychiatric patients could result in a reduction on number of drugs required to control exacerbations, and the underlying pathologies, reducing the risk of adverse effects and improving adherence to treatment, leading to a potential decrease in direct costs. This methodology has been shown to be cost-dominant and, being based on a pharmacogenetic analysis, it has a lifelong nature, as the data obtained can be applied to other medical disciplines.

Ten Years of Experience Support Pharmacogenetic Testing to Guide Individualized Drug Therapy

“…An economic impact of the model in psychotic patients has been previously reported [41]. In this study, we achieved a reduction in direct costs, including both hospitalization and pharmacotherapy, as well as a reduction in total costs in 67% of patients who underwent the application of this pharmacogenetic approach.…”

Real-World Impact of a Pharmacogenomics-Enriched Comprehensive Medication Management Program

“…Indeed, outcome-oriented studies repeatedly demonstrate positive impacts of PGx on individuals [ 3 , 4 , 5 ], providers [ 6 , 7 ], and the healthcare system [ 8 , 9 ]. Oncology [ 10 , 11 ] and psychiatry [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] implementations demonstrate particularly well-documented improvements. Further, a variety of positive economic, clinical, and humanistic outcomes (ECHO) associated with PGx have also been described.…”

A systematic review of pharmacogenetic testing to guide antipsychotic treatment

“…Carrascal-Laso et al 23 demonstrated that, before applying the pharmacogenetics test, participants in the study accounted for 504 hospitalization stays. This was reduced to 218 hospitalizations after adjusting treatment on the basis of the pharmacogenetics test.…”

“…Pharmacogenetics (treatment resistant) ( n = 42) versus TAU ( n = 62) Age, mean (years): 18.79 versus 13.83 Sex (% female): 26% versus 8% Ethnicity: N/A Medication (%): antipsychotics, 67 versus 32; antidepressants, 48 versus 11; anxiolytics, anticonvulsants and others, 26 versus 56; no current medication, 7 versus 0 Diagnosis: 100% autism spectrum disorder Symptom severity (using CGI and CGAS) Antipsychotics, antidepressants, anxiolytics and anticonvulsants CYP1A2 , CYP2C19 , CYP2D6 and SLC6A4 Studies with one comparator Carrascal-Laso et al 22 2020 Spain Retrospective observational study One arm: pharmacogenetics only Time horizon: 3 years Total sample ( n = 188) offered pharmacogenetics test. Age, median (years): 47 Sex (% female): 37.8% Ethnicity: N/A Medication (%): N/A Diagnosis (%): dementia, 0.53; substance-related disorder 6.38; schizophrenia, 67.02; persistent delusional disorder, 1.06; brief and acute psychotic disorder, 0.53; schizoaffective disorder, 6.92; bipolar disorder, 13.30; major depressive disorder, 0.53; specific personality disorder, 1.06; mixed personality disorder, 0.53; intellectual disability, 1.06 Mean daily dose Polytherapy cases Antipsychotics CYP1A2 , CYP2B6 , CYP2C9 , CYP2C19 , CYP2D6 , CYP3A5 and ABCB1 Carrascal-Laso et al 23 2021 Spain Retrospective observational study One arm: pharmacogenetics only Time horizon: 3 years Total sample ( n = 188) offered pharmacogenetics test. Age, median (years): 47 Sex (% female): 37.8% Ethnicity: N/A Medication (%): N/A Diagnosis (%): dementia, 0.53; substance-related disorder 6.38; schizophrenia, 67.02; persistent delusional disorder, 1.06; brief and acute psychotic disorder, 0.53; schizoaffective disorder, 6.92; bipolar disorder, 13.30; major depressive disorder, 0.53; specific personality disorder, 1.06; mixed personality disorder, 0.53; intellectual disability, 1.06 Pharmaceutical costs Hospitalization costs Antipsychotics CYP1A2 , CYP2B6 , CYP2C9 , CYP2C19 , CYP2D6 , CYP3A5 and ABCB1 Walden et al 25 2019 Canada Prospective observational study One arm: pharmacogenetics only Assessment points: baseline, 6 weeks and 12 weeks Total sample ( n ...…”

“…The sample size of the studies ranged from 80 to 290 participants, and the average age ranged from 14 to 49 years. Regarding gender, most studies were well balanced, except three studies that included less than 40% female participants 21 – 23 and one study that included only male participants 24 . Most studies were conducted in Europe and North America, although there was one study conducted in China 24 .…”