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An economic model of the cost-utility of pre-emptive genetic testing to support pharmacotherapy in patients with major depression in primary care

The Pharmacogenomics Journal volume 19, pages 480–489 (2019)Cite this article

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Abstract

The pharmacokinetics of many antidepressants (tricyclic antidepressants (TCA) or selective serotonin re-uptake inhibitors (SSRI)) are influenced by the highly polymorphic CYP2D6 enzyme. Therefore, pharmacogenetics could play an important role in the treatment of depressive patients. The potential cost-utility of screening patients is however still unknown. Therefore, a Markov model was developed to compare the strategy of screening for CYP2D6 and subsequently adjust antidepressant treatment according to a patient’s metabolizer profile of poor, extensive, or ultra metabolizer, with the strategy of no screening (‘one size fits all’ principle). Each week a patient had a probability of side effects, which was followed by dosage titration or treatment switching. After 6 weeks treatment effect was evaluated followed by treatment adjustments if necessary, with a total time horizon of the model of 12 weeks. The analysis was performed from a societal perspective. The strategy of screening compared with no screening resulted in incremental costs of €91 (95 percentiles: €39; €152) more expensive but also more effect with 0.001 quality adjusted life years (QALYs) (95 percentiles: 0.001; 0.002) gain. The incremental cost-effectiveness ratio (ICER) was therefore €77,406 per QALY gained, but varied between €22,500 and €377,500 depending on the price of screening and productivity losses. According to our model, we cannot unequivocally conclude that screening for CYP2D6 in primary care patients using antidepressants is be cost-effective, as the results are surrounded by large uncertainty. Therefore, information from ongoing studies should be used to reduce these uncertainties.

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Funding

An unrestricted grant was received from Royal Dutch Pharmacists Association (KNMP), The Hague, in The Netherlands. The funding body had no role in the analysis or interpretation of the findings of this article.

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Authors and Affiliations

  1. Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Reinier L. Sluiter & Wietske Kievit

  2. Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands

    Joost G. E. Janzing

  3. Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands

    Gert Jan van der Wilt

  4. Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands

    Martina Teichert

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  1. Reinier L. Sluiter
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Correspondence to Reinier L. Sluiter.

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Sluiter, R.L., Janzing, J.G.E., van der Wilt, G.J. et al. An economic model of the cost-utility of pre-emptive genetic testing to support pharmacotherapy in patients with major depression in primary care. Pharmacogenomics J 19, 480–489 (2019). https://doi.org/10.1038/s41397-019-0070-8

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