Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?

Verbelen, Moira; Weale, Michael E.; Lewis, Cathryn M.

doi:10.1101/065540

Cited by 23 publications

(32 citation statements)

References 62 publications

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“…This and the other steps needed for routine clinical application of pharmacogenetic testing require robust cost-effectiveness evidence before implementation. 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].…”

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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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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“…Additionally, testing costs significantly influence the value of personalized treatments and may not always be cost-effective. 92 The limited data from pragmatic studies with long-term outcomes further complicates value analysis. 93 Ongoing trials, adoption of electronic health records (EHR), and the ability to generate "big data" may address some barriers.…”

Section: Health Outcomesmentioning

confidence: 99%

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Caudle

Gammal

Karnes

et al. 2019

J Am Coll Clin Pharm

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Clinical pharmacists have been incorporating precision medicine into practice for decades. Drug selection and dosing based on patient‐specific clinical factors such as age, weight, renal function, drug interactions, plasma drug concentrations, and diet are expected as part of routine clinical practice. Newer concepts of precision medicine such as pharmacogenomics have recently been implemented into clinical care, while other concepts such as epigenetics and pharmacomicrobiomics still predominantly exist in the research area but clinical translation is expected in the future. The purpose of this paper is to describe current and emerging aspects of precision medicine as it relates to clinical pharmacy across a variety of specialty areas of practice, with perspectives from the American College of Clinical Pharmacy Practice and Research Network membership.

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“…Specifically, the ongoing benefits of pharmacogenetic testing may decrease the cost of hospitalization and healthcare treatment due to ineffective therapies or severe side effects that could have been avoided with genetic testing and tailored medical treatment [102,111]. In fact, most pharmacoeconomic studies support the pharmacogenetic testing is a cost-effective or cost-saving strategy [112,113].…”

Section: Implementation Of Pharmacogeneticsmentioning

confidence: 99%

Pharmacogenetics: An Important Part of Drug Development with A Focus on Its Application

Oates¹,

Lopez²

2018

Int J Biomed Investig

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Since the human genome project in 2003, the view of personalized medicine to improve diagnosis and cure diseases at the molecular level became more real. Sequencing the human genome brought some benefits in medicine such as early detection of diseases with a genetic predisposition, treating patients with rare diseases, the design of gene therapy and the understanding of pharmacogenetics in the metabolism of drugs. This review explains the concepts of pharmacogenetics, polymorphisms, mutations, variations, and alleles, and how this information has helped us better understand the metabolism of drugs. Multiple resources are presented to promote reducing the gap between scientists, physicians, and patients in understanding the use and benefits of pharmacogenetics. Some of the most common clinical examples of genetic variants and how pharmacogenetics was used to determine treatment options for patients having these variants were discussed. Finally, we evaluated some of the challenges of implementing pharmacogenetics in a clinical setting and proposed actions to be taken to make pharmacogenetics a standard diagnostic tool in personalized medicine.

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Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?

Cited by 23 publications

References 62 publications

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

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

PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas

Pharmacogenetics: An Important Part of Drug Development with A Focus on Its Application

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