Economic Evaluations of Pharmacogenetic and Pharmacogenomic Screening Tests: A Systematic Review. Second Update of the Literature

Abstract

ObjectiveDue to extended application of pharmacogenetic and pharmacogenomic screening (PGx) tests it is important to assess whether they provide good value for money. This review provides an update of the literature.MethodsA literature search was performed in PubMed and papers published between August 2010 and September 2014, investigating the cost-effectiveness of PGx screening tests, were included. Papers from 2000 until July 2010 were included via two previous systematic reviews. Studies’ overall quality was assessed with the Quality of Health Economic Studies (QHES) instrument.ResultsWe found 38 studies, which combined with the previous 42 studies resulted in a total of 80 included studies. An average QHES score of 76 was found. Since 2010, more studies were funded by pharmaceutical companies. Most recent studies performed cost-utility analysis, univariate and probabilistic sensitivity analyses, and discussed limitations of their economic evaluations. Most studies indicated favorable cost-effectiveness. Majority of evaluations did not provide information regarding the intrinsic value of the PGx test. There were considerable differences in the costs for PGx testing. Reporting of the direction and magnitude of bias on the cost-effectiveness estimates as well as motivation for the chosen economic model and perspective were frequently missing.ConclusionsApplication of PGx tests was mostly found to be a cost-effective or cost-saving strategy. We found that only the minority of recent pharmacoeconomic evaluations assessed the intrinsic value of the PGx tests. There was an increase in the number of studies and in the reporting of quality associated characteristics. To improve future evaluations, scenario analysis including a broad range of PGx tests costs and equal costs of comparator drugs to assess the intrinsic value of the PGx tests, are recommended. In addition, robust clinical evidence regarding PGx tests’ efficacy remains of utmost importance.

“What Goes Around Comes Around”: Lessons Learned from Economic Evaluations of Personalized Medicine Applied to Digital Medicine

“…In a review covering studies of personalized medicine published between 2010 – 2014, 84% of studies (N=38) reported that their findings indicated favorable cost-effectiveness. (42) These results are similar to those for other medical interventions. (24) In comparison, our review of digital biomarker technologies suggests that these technologies may be less likely to be cost-effective than personalized medicine or other technologies although the small number of studies found precludes any definitive conclusions.…”

Precision Medicine: From Science To Value

“…Several structured reviews of economic evaluations of PM have been published (41–53). Many of these reviews have focused on evaluations of pharmacogenetic testing while others have focused on PM more broadly and one study focused on sequencing (52).…”

The Value of Pharmacogenomic Information

“…John A. Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al 2016;Verhoef et al 2016; Kazi et al 2014).…”

“…John A. Existing research on the value of pharmacogenomics has focused primarily on the shortterm cost effectiveness of single gene tests-an approach that ignores the potential lifetime value of multiplexed genetic testing strategies (Berm et al 2016;Verhoef et al 2016; Kazi et al 2014).Compared with single gene testing, these strategies-which include whole genome sequencing (WGS), whole exome sequencing (WES) and multiplexed genetic panel testing-facilitate the acquisition of wide swaths of genetic information all at once. Thus, a drug-gene pair for which single-gene testing is found to be cost-ineffective could potentially improve overall value when integrated within a broader multiplexed testing strategy, since information on that gene can are not better understood it will be difficult if not impossible to capture the potential value of pharmacogenomics in particular and precision medicine more broadly.…”