Cost-Effectiveness of a Pharmacogenetic Test to Guide Treatment for Major Depressive Disorder

• DOI: 10.18553/jmcp.2018.24.8.726
• Publication Date: 2018-07-30T14:13:23Z
• Authors: Erik J. Groessl; Steven R. Tally; Naomi Hillery; Alejandra Maciel; Jorge A. Garces
• Keywords: Depressive Disorder, Major; Pharmacogenomic Variants; Cost-Benefit Analysis; Health Care Costs; Middle Aged; Severity of Illness Index; Antidepressive Agents; Markov Chains; Pharmacogenomic Testing; 3. Good health; Survival Rate; Suicide; 03 medical and health sciences; Models, Economic; Treatment Outcome; 0302 clinical medicine; Cost Savings; Quality of Life; Humans; Quality-Adjusted Life Years; Precision Medicine; Randomized Controlled Trials as Topic

Recent clinical trials indicate that pharmacogenetic-guided treatment of major depressive disorder (MDD) results in higher response rates by genetically matching patients to medications and avoiding a trial-and-error process.To evaluate the cost-effectiveness pharmacogenetic test (IDGx) has demonstrated effectiveness compared with standard care (SOC) medication management among varied MDD severity.Data from large prospective, randomized controlled trial treatment-naive or inadequately general practice psychiatric settings were used build Markov state-transition probability model. Analyses conducted societal perspective. Treatment rates, mortality direct indirect medical costs, utility inputs derived reference study published scientific literature. The cost was $2,000. A 3% discount rate costs effects. Univariate one-way sensitivity analyses performed determine effect input parameters on net monetary benefit.For moderate severe MDD, model estimated cumulative over 3 years 2.07 quality-adjusted life-years (QALYs) for group 1.97 QALYs SOC group, including lower death suicide (0.328% 0.351%, respectively). Total $44,697 $47,295 (SOC). This difference includes savings $2,918 $1,680 costs. Results more pronounced when only severely depressed evaluated.Pharmacogenetic testing improved resulted savings. Sensitivity supported robust nature current findings dominant IDGx guide treatment.Funding this analysis provided AltheaDx, which is manufacturer IDgenetix test. AltheaDx personnel assisted design, data collection, review manuscript. Maciel Garces are employed AltheaDx. Groessl received funding as consultant American Specialty Health.