Cost-effectiveness of pharmacogenomic-guided treatment for major depression

• Published in: Canadian Medical Association journal (CMAJ) Vol. 195; no. 44; pp. E1499 - E1508
• Main Authors: Ghanbarian, Shahzad, Wong, Gavin W K, Bunka, Mary, Edwards, Louisa, Cressman, Sonya, Conte, Tania, Price, Morgan, Schuetz, Christian, Riches, Linda, Landry, Ginny, Erickson, David, McGrail, Kim, Peterson, Sandra, Vijh, Rohit, Hoens, Alison M, Austin, Jehannine, Bryan, Stirling
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 14.11.2023
• Subjects: Adult; Analysis; Antidepressants; Antidepressive Agents - therapeutic use; British Columbia; Care and treatment; Cost-Benefit Analysis; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - genetics; Economic aspects; Evaluation; Evidence-based medicine; Humans; Major depressive disorder; Medical care, Cost of; Medical research; Medicine, Experimental; Patient outcomes; Pharmacogenetics; Quality-Adjusted Life Years; British Columbia; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.221785

Pharmacogenomic testing to identify variations in genes that influence metabolism of antidepressant medications can enhance efficacy and reduce adverse effects of pharmacotherapy for major depressive disorder. We sought to establish the cost-effectiveness of implementing pharmacogenomic testing to guide prescription of antidepressants. We developed a discrete-time microsimulation model of care pathways for major depressive disorder in British Columbia, Canada, to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing from the public payer's perspective over 20 years. The model included unique patient characteristics (e.g., metabolizer phenotypes) and used estimates derived from systematic reviews, analyses of administrative data (2015-2020) and expert judgment. We estimated incremental costs, life-years and quality-adjusted life-years (QALYs) for a representative cohort of patients with major depressive disorder in BC. Pharmacogenomic testing, if implemented in BC for adult patients with moderate-severe major depressive disorder, was predicted to save the health system $956 million ($4926 per patient) and bring health gains of 0.064 life-years and 0.381 QALYs per patient (12 436 life-years and 74 023 QALYs overall over 20 yr). These savings were mainly driven by slowing or avoiding the transition to refractory (treatment-resistant) depression. Pharmacogenomic-guided care was associated with 37% fewer patients with refractory depression over 20 years. Sensitivity analyses estimated that costs of pharmacogenomic testing would be offset within about 2 years of implementation. Pharmacogenomic testing to guide antidepressant use was estimated to yield population health gains while substantially reducing health system costs. These findings suggest that pharmacogenomic testing offers health systems an opportunity for a major value-promoting investment.