Economic evaluation in psychiatric pharmacogenomics: a systematic review

Abstract

Nowadays, many relevant drug-gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were costeffective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug-gene associations and for combinatorial PGx panels, but evidence is limited for many other drug-gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.

The Identification of Novel CYP2D6 Variants in US Hmong: Results From Genome Sequencing and Clinical Genotyping

“…Implementing pharmacogenetic (PGx) testing for clinical practice has been shown to positively impact patient outcomes in a variety of settings and medical conditions ( Cavallari et al, 2018 ; Smith et al, 2019 ; Hulot et al, 2020 ). In select cases and healthcare systems, this practice has been demonstrated to be cost-effective ( Tanner et al, 2020 ; Karamperis et al, 2021 ; Kim et al, 2021 ; Zhu et al, 2021 ). However, our ability to develop, validate and utilize clinical guidelines in an equitable manner for all members of society is hindered by the lack of population-specific PGx knowledge.…”

What Are the Barriers and Enablers to the Implementation of Pharmacogenetic Testing in Mental Health Care Settings?

“…Rather they explored cost in general terms. Cost-effectiveness of psychiatric PGx was beyond the scope of this review, therefore for further information we would refer the reader to a recent systematic review; an economic evaluation on psychiatric PGx (Karamperis et al, 2021). This shows early studies assessing costeffectiveness are promising but are limited by small sample sizes and high heterogeneity, and as such more research is needed.…”

Approaches and hurdles of implementing pharmacogenetic testing in the psychiatric clinic

“…Notably, willingness‐to‐pay thresholds are defined on a national level and vary by country. For example, the United Kingdom has a threshold of £20,000, whereas a value between $50,000 and $70,000 is considered cost‐effective in the United States 48 . Additional economic evaluations addressing this and other limitations will be needed before firm conclusions about the cost‐effectiveness of PGx testing in psychiatry can be made.…”

“…47 Pragmatic studies are more generalizable, less costly, and more efficient to conduct compared to RCTs; however, they are prone to selection bias and confounding. 42 shown PGx testing to be a cost-effective or cost-saving strategy, 48 few studies have been conducted in the mental health-care context.…”