Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

Heitjan, Daniel F.; Asch, David A.; Ray, Radharaman; Rukstalis, Margaret; Patterson, Freda; Lerman, Caryn

doi:10.1038/sj.tpj.6500492

Cited by 33 publications

(38 citation statements)

References 58 publications

(78 reference statements)

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“…Heitjan et al [2008] demonstrated that an untailored approach of treatment with either bupropion or varenicline is cost-effective for tobacco dependence and that a tailored approach selecting between bupropion and NRT transdermal nicotine is nearly as effective as varenicline, at a savings of 15% in lifetime smoking-cessation costs. Even in a single-gene-based cost-effectiveness analysis of pharmacotherapy for smoking cessation, the most cost-effective strategy is to prescribe both NRT and bupropion regardless of genotype [Welton et al, 2008].…”

Section: Discussionmentioning

confidence: 98%

Pharmacogenetics of smoking cessation therapy

Kortmann

Dobler

Bizarro

et al. 2009

American J of Med Genetics Pt B

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Nicotine dependence is a major health problem, with a large amount of smoking-related premature deaths and disabilities. The dependence mechanism of nicotine is especially complex and is under strong genetic influence. Smoking cessation is associated with substantial health benefits. Evidence from animal and human studies suggests that genetic polymorphisms influencing pharmacokinetics and pharmacodynamics of nicotine may have great potential for aiding smoking treatment. There are more than 30 association studies and one genome-wide association study (GWAS) between genetic polymorphisms and smoking cessation following nicotine replacement therapy (NRT) and/or bupropion therapy. However, only a few candidate genes or regions were analyzed more than twice and even these genes require additional investigations in different therapeutic schemes. There are a growing number of new pharmacologic options that have not been pharmacogenetically assessed according to published literature. In addition, molecular genetics studies are needed to assess the functional mechanisms of some putative association results. Taken together, the preliminary findings are promising but raise the need for new studies with adequate sample sizes and adjustment for several potential confounding factors frequently neglected, such as comorbidity and sociodemographic factors. The current state of the art in the field encourages an optimist view that personalized treatment approaches may become possible. However, the current scientific evidence still does not support the use of pharmacogenetic tests in routine smoking cessation therapy.

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Section: Discussionmentioning

confidence: 98%

Pharmacogenetics of smoking cessation therapy

Kortmann

Dobler

Bizarro

et al. 2009

American J of Med Genetics Pt B

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“…Results of one study indicated the use of genetic testing in tailoring smoking cessation treatment to be costeffective under certain assumptions. 23 By contrast, the other study cautioned against assuming that genetic tailoring of treatment would be more cost-effective than current models for pharmacotherapy. 22 Six studies included in this review were CUAs, but only five of these stated ICERs.…”

Section: Genetics In Medicine • Volume 13 Number 2 February 2011mentioning

confidence: 99%

“…20 The cost-effectiveness of pharmacogenetic testing for smoking cessation treatment was evaluated by two other of the studies reviewed. 22,23 Both studies included nicotine replacement and bupropion pharmacotherapy among the strategies evaluated. Results of one study indicated the use of genetic testing in tailoring smoking cessation treatment to be costeffective under certain assumptions.…”

Section: Genetics In Medicine • Volume 13 Number 2 February 2011mentioning

confidence: 99%

A review of economic evaluations of genetic testing services and interventions (2004–2009)

Djalalov

Musa

Mendelson³

et al. 2011

Genetics in Medicine

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Abstract:To review economic evaluations of genetic interventions published between 2004 and 2009 and assess the quality of the identified studies, we searched for economic evaluations of genetic testing and interventions published between 2004 and 2009. Studies that met inclusion criteria were reviewed and their quality then assessed using a validated instrument-the Quality of Health Economic Studies. Of 54 articles identified, 26 met study criteria and were included in the review. These studies span a number of clinical indications, genetic tests, and interventions, but the majority (92%) focuses on genetic interventions for preventive screening and increasing treatment efficacy. The mean quality score for the reviewed studies was 89.8. Comparison of the quality of different study types revealed that cost-utility studies and studies that used a combined decision tree and Markov model had the highest mean quality scores. Clear statements regarding bias, funding source, and study perspective were commonly lacking in the reviewed studies. Although the reviewed studies were of fairly high quality, we found Quality of Health Economic Studies methodology for grading the quality of economic evaluations challenging and observed no statistically significant improvement in quality of studies between the periods

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“…Modeling exercises, however, suggest that genetic tailoring of smoking cessation pharmacotherapy may not be cost-effective, 34 even with favorable assumptions (eg, a single-gene test for a somewhat common allele with a substantial relative risk). 35,36 …”

Section: Evidence That Genetic Knowledge Increases Smoking Cessationmentioning

confidence: 99%

Personalized Medicine and Tobacco-Related Health Disparities: Is There a Role for Genetics?

Carlsten

Halperin²,

Crouch³

et al. 2011

The Annals of Family Medicine

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Genetic testing has been proposed as a means to increase smoking cessation rates and thus reduce smoking prevalence. To understand how that might be practically possible, with appreciation of the current social context of tobacco use and dependence, we performed a contextual analysis of smoking-related genetics and smoking cessation. To provide added value, genetics would need to inform and improve existing interventions for smokers (including behavioral and pharmacological treatments). Pharmacogenetics offers the most promising potential, because it may improve the effi cacy of medication-based smoking cessations strategies. All proven interventions for treating tobacco dependence, however, including simple cost-effective measures, such as quit lines and physician counseling, are underutilized. As tobacco use occurs disproportionately among disadvantaged populations, efforts to improve smokers' access to health care, and to the tools that are known to help them quit, represent the most promising approaches for reducing smoking prevalence within these groups. Similar considerations apply to other chronic diseases contributing to population-level health disparities. We conclude that although genetics offers increasing opportunities to tailor drug treatment, and may in some cases provide useful risk prediction, other methods of personalizing care are likely to yield greater benefi t to populations experiencing health disparities related to tobacco use.

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Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

Cited by 33 publications

References 58 publications

Pharmacogenetics of smoking cessation therapy

Pharmacogenetics of smoking cessation therapy

A review of economic evaluations of genetic testing services and interventions (2004–2009)

Personalized Medicine and Tobacco-Related Health Disparities: Is There a Role for Genetics?

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