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

Abstract

Pharmacogenetics (PGx) has the potential to personalize pharmaceutical treatments. Many relevant gene–drug associations have been discovered, but PGx-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health-care. We reviewed economic evaluations for PGx associations listed in the US Food and Drug Administration (FDA) Table of Pharmacogenomic Biomarkers in Drug Labeling. We determined the proportion of evaluations that found PGx-guided treatment to be cost-effective or dominant over the alternative strategies, and estimated the impact on this proportion of removing the cost of genetic testing. Of the 137 PGx associations in the FDA table, 44 economic evaluations, relating to 10 drugs, were identified. Of these evaluations, 57% drew conclusions in favour of PGx testing, of which 30% were cost-effective and 27% were dominant (cost-saving). If genetic information was freely available, 75% of economic evaluations would support PGx-guided treatment, of which 25% would be cost-effective and 50% would be dominant. Thus, PGx-guided treatment can be a cost-effective and even a cost-saving strategy. Having genetic information readily available in the clinical health record is a realistic future prospect, and would make more genetic tests economically worthwhile.

Clinical Implementation of Pharmacogenetic Testing in a Hospital of the Spanish National Health System: Strategy and Experience Over 3 Years

“…The calculated costs are frequently lower than those described even for just genotyping in the United States and other countries. 23 Despite that our costs seem cost-effective and similar to usual procedures within our NHS, a formal cost-efficiency study of our strategy would be necessary for stronger institutional support and expansion.…”

Pharmacogenetic testing in oncology: a Brazilian perspective

“…A systematic review of drug-induced adverse effects identified evidence supporting the cost-effectiveness of testing for HLA-B*57:01 (prior to abacavir), HLA-B*15:02 and HLA-A*31:01 (carbamazepine), HLA-B*58:01 (allopurinol), CYP2C19 (clopidogrel) and UGT1A1 (irinotecan); evidence was inconclusive for TPMT (thiopurines) 29 . Verbelen et al 30 carried out a thorough analysis of PGx testing for the biomarkers listed in the FDA-approved drug labels. Data for pharmaco-economic evaluation were available for 44 studies of 10 drugs, of which “57% drew conclusions in favor of PGx testing...30% were cost-effective (PGx was more effective at acceptable additional cost) and 27% were cost-saving/dominant (PGx was more effective at lower cost).”…”

Pharmacogenomics: An evolving clinical tool for precision medicine

“…39 But several studies have shown that preemptive pharmacogenomic testing could not only benefi t patients, it may also be costeffective over the long term. In a systematic review, Verbelen et al 40 assessed 44 economic evaluations that covered 10 of the known pharmacogenomic-associated drugs listed by the FDA. They found that 57% supported reactive pharmacogenomic testing, with 30% being cost-effective (ie, benefi ts are large compared with costs) and 27% estimated to be cost-saving (ie, costs are reduced).…”