Value Assessment for Genetic Testing of Drug Variation In An Elderly Population

Biskupiak, JE; Biltaji, Eman; Bress, Adam P.; Unni, Sudhir; Ye, X; Yu, Bolan; Mamiya, T; Brixner, Diana

doi:10.1016/j.jval.2015.09.2883

Cited by 2 publications

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“…For these patients, information about different genes might be beneficial and cost-effective due to multiple drug-gene interactions. Pharmacogenetic tests which asses these multi-drug and gene interaction can be key towards cost-effectiveness of genotyping, although the generalizability of these studies will be challenging [47,48]. Besides genotyping costs, the main parameters which influenced the ICER were the improvement in the duration of hospitalization among correctly dosed patients, mean duration of hospitalization, and the proportion of patients who discontinued nortriptyline pharmacotherapy.…”

Section: Discussionmentioning

confidence: 99%

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

et al. 2016

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ObjectiveGenotyping for CYP2D6 has the potential to predict differences in metabolism of nortriptyline. This information could optimize pharmacotherapy. We determined the costs and effects of routine genotyping for old aged Dutch depressed inpatients.MethodsWith a decision-tree, we modelled the first 12 weeks of nortriptyline therapy. Direct costs of genotyping, hospitalization, therapeutic drug monitoring and drugs were included. Based on genotype, patients could be correctly, sub-, or supratherapeutically dosed. Improvement from sub- or supratherapeutically dosed patients to correctly dosed patients was simulated, assuming that genotyping would prevent under- or overdosing of patients. In the base case, this improvement was assumed to be 35%. A probabilistic sensitivity analysis (PSA) was performed to determine uncertainty around the incremental cost-effectiveness ratio (ICER).ResultsIn the base case analysis, costs for genotyping were assumed €200 per test with a corresponding ICER at €1 333 000 per QALY. To reach a €50 000 per QALY cut-off, genotyping costs should be decreased towards €40 per test. At genotyping test costs < €35 per test, genotyping was dominant. At test costs of €17 per test there was a 95% probability that genotyping was cost-effective at €50 000 per QALY.ConclusionsCYP2D6 genotyping was not cost-effective at current genotyping costs at a €50 000 per QALY threshold, however at test costs below €40, genotyping could be costs-effective.

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Section: Discussionmentioning

confidence: 99%

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

et al. 2016

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Assessing Individual Health Insurance Coverage and Utilization Before and After the Patient Protection and Affordable Care Act

Jefferson

Phillips‐Wren

Sharkey

2016

International Journal of Strategic Decision Sciences

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The adoption of the Patient Protection and Affordable Care Act (PPACA) in 2010 with the intent to improve the U.S. health care delivery system by expanding health insurance coverage and controlling health care costs has generated intense debate regarding its implementation. Marketplaces known as insurance exchanges have been established to provide coverage for Americans who otherwise could not get affordable health care benefits. These exchanges have been plagued with financial losses and other challenges leading to several large insurance providers discontinuing participation in the program. There are many possible remedies under consideration to make the program work better. This research seeks to support program evaluation as well as potential modifications to the law by providing baseline data to compare access and costs in states with state-based exchanges compared to states with federal exchanges. The authors perform an analysis by state for the years 2012 and 2013 (pre-PPACA implementation) using data from the Current Population Survey (U.S. Census) as well as de-identified claims data from Inovalon, Inc.

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Value Assessment for Genetic Testing of Drug Variation In An Elderly Population

Cited by 2 publications

References 0 publications

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

Assessing Individual Health Insurance Coverage and Utilization Before and After the Patient Protection and Affordable Care Act

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