Estimating cost savings of pharmacogenetic testing for depression in real-world clinical settings

Maciel, Alejandra; Cullors, Ali; Lukowiak, Andrew A.; Garcés, Jorge

doi:10.2147/ndt.s145046

Cited by 45 publications

(27 citation statements)

References 23 publications

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“…As cost-effectiveness is still considered a major barrier for the clinical implementation of pharmacogenetics 48 , we suggest that current genotyping microarrays constitute the most cost-effective technology with acceptable accuracy. Several studies have found pre-emptive pharmacogenetic testing cost-efficient with per-patient savings ranging from 5,962-10,667 USD [49][50][51] , despite the reported costs of pharmacogenetic testing to be over 2,000 USD 49 . Thus, both genotyping and developing tools for translating pre-existing genome-wide genotype data into clinical recommendations can be considered very reasonable healthcare investments.…”

Section: Discussionmentioning

confidence: 99%

Translating genotype data of 44,000 biobank participants into clinical pharmacogenetic recommendations: challenges and solutions

Reisberg

Krebs

Kals

et al. 2018

Preprint

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A telephone number and e-mail address to whom correspondence concerning the manuscript should be sent lili.milani@ut.ee +372 5304 5400 2 Conflict of interest notification pageConflict of interest V.M.L is a co-founder and owner of HepaPredict AB. Other authors have no conflict of interest to declare. ABSTRACT AND KEYWORDS PurposeBiomedical databases combining electronic medical records, phenotypic and genomic data constitute a powerful resource for the personalization of treatment. To leverage the wealth of information provided, algorithms are required that systematically translate the contained information into treatment recommendations based on existing genotype-phenotype associations. MethodsWe developed and tested algorithms for translation of pre-existing genotype data of over 44,000 participants of the Estonian biobank into pharmacogenetic recommendations. We compared the results obtained by whole genome sequencing, whole exome sequencing and genotyping using microarrays, and evaluated the impact of pharmacogenetic reporting based on drug prescription statistics in the Nordic countries and Estonia. ResultsOur most striking result was that the performance of genotyping arrays is similar to that of whole genome sequencing, whereas exome sequencing is not suitable for pharmacogenetic predictions. Interestingly, 99.8% of all assessed individuals had a genotype associated with increased risks to at least one medication, and thereby the implementation of pharmacogenetic recommendations based on genotyping affects at least 50 daily drug doses per 1000 inhabitants. ConclusionWe find that microarrays are a cost-effective solution for creating pre-emptive pharmacogenetic reports, and with slight modifications, existing databases can be applied for automated pharmacogenetic decision support for clinicians.

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Section: Discussionmentioning

confidence: 99%

Translating genotype data of 44,000 biobank participants into clinical pharmacogenetic recommendations: challenges and solutions

Reisberg

Krebs

Kals

et al. 2018

Preprint

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show abstract

“…A medical intervention is defined as cost-effective when it costs more than standard care, but the extra-cost is considered acceptable based on the improvements in clinical outcomes, according to what is usually defined as willingness to pay threshold [25]. There are a few published studies looking at the cost-effectiveness of pharmacogenetic testing in guiding antidepressant prescription compared to standard care [26][27][28]. They reported evidence of cost-effectiveness compared to standard care, even though they were based on simulated clinical outcomes using input data from short-term clinical trials, while results coming from longer follow-up non-sponsored studies are lacking.…”

Section: Barriers To the Clinical Implementation Of Pharmacogeneticsmentioning

confidence: 99%

Genetics of Treatment Outcomes in Major Depressive Disorder: Present and Future

Fabbri

Serretti

2020

Clin Psychopharmacol Neurosci

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Pharmacogenetic testing is a useful and increasingly widespread tool to assist in antidepressant prescription. More than ten antidepressants (including tricyclics, selective serotonin reuptake inhibitors and venlafaxine) have already genetic biomarkers of response/side effects in clinical guidelines and drug labels. These are represented by functional genetic variants in genes coding for cytochrome enzymes (CYP2D6 and CYP2C19). Depending on the predicted metabolic activity, guidelines provide recommendations on drug choice and dosing. Despite not conclusive, the current evidence suggests that testing can be useful in patients who did not respond or tolerate at least one previous pharmacotherapy. However, the current recommendations are based on pharmacokinetic genes only (CYP450 enzymes), while pharmacodynamic genes (modulating antidepressant mechanisms of action in the brain) are still being studied because of their greater complexity. This may be captured by polygenic risk scores, which reflect the cumulative contribution of many genetic variants to a trait, and they may provide future clinical applications of pharmacogenetics. A more extensive use of genotyping in clinical practice may lead to improvement in treatment outcomes thanks to personalized treatments, but possible ethical issues and disparities should be taken into account and prevented.

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“…However, another study analyzing the cost-effectiveness of introducing a pharmacogenetic test (NeuroIDgenetix) in treatment plans for major depression provides a different perspective [3]. It mentions that, in 2016, the total per-patient economic burden of major depressive disorder was US $34,585.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…It mentions that, in 2016, the total per-patient economic burden of major depressive disorder was US $34,585. After integrating the pharmacogenetic test in treatment plans, the charge reduced to US $27,099, which saved the economy approximately US $7,486 [3].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Literature Review Concerning the Challenges of Implementing Pharmacogenetics in Primary Care Practice

Omer

2020

Cureus

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Since President Obama signed the Precision Medicine Initiative in 2015, endeavors to integrate pharmacogenetics in clinical practice and psychiatric care have been evolving rapidly. The nature of general practice and psychiatric medicine, including psychopharmacotherapy and the long-term care necessary for chronic diseases, renders these fields in desperate need of the implementation of pharmacogenetics. This article presents some of the challenges facing pharmacogenetics implementation in family medicine and psychiatric care. Reputable research websites were used to extract papers, data, and lectures concerning this topic. The results reveal that three main challenges are facing this integration: the evaluation of pharmacogenetic testing in general and psychiatric practice, cost-effectiveness, and regulatory burdens. Although considerable advances are being made to address these issues, it is time to gather these efforts under one umbrella to create guidelines based on previous and upcoming research.

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Estimating cost savings of pharmacogenetic testing for depression in real-world clinical settings

Cited by 45 publications

References 23 publications

Translating genotype data of 44,000 biobank participants into clinical pharmacogenetic recommendations: challenges and solutions

Translating genotype data of 44,000 biobank participants into clinical pharmacogenetic recommendations: challenges and solutions

Genetics of Treatment Outcomes in Major Depressive Disorder: Present and Future

Literature Review Concerning the Challenges of Implementing Pharmacogenetics in Primary Care Practice

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