Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

• Published in: The pharmacogenomics journal Vol. 8; no. 6; pp. 391 - 399
• Main Authors: Heitjan, D F, Asch, D A, Ray, Riju, Rukstalis, Margaret, Patterson, Freda, Lerman, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2008; Nature Publishing Group
• Subjects: Benzazepines - administration & dosage; Benzazepines - pharmacology; Biomedical and Life Sciences; Biomedicine; Bupropion; Bupropion - administration & dosage; Bupropion - pharmacology; Care and treatment; Cigarette smoking; Cost analysis; Cost-Benefit Analysis; Drug addiction; Economic aspects; Gene Expression; Genetic aspects; Genetic screening; Genotype; Human Genetics; Humans; Monte Carlo simulation; Nicotine; Oncology; original-article; Pharmacogenetics; Pharmacotherapy; Psychopharmacology; Quinoxalines - administration & dosage; Quinoxalines - pharmacology; Receptors, Nicotinic - drug effects; Sensitivity analysis; Smokers; Smoking; Smoking Cessation - economics; Smoking cessation products; Varenicline; United States; tobacco dependence; genetic testing; Monte Carlo simulation; addiction
• ISSN: 1470-269X; 1473-1150
• DOI: 10.1038/sj.tpj.6500492

We evaluated the cost-effectiveness of a range of smoking cessation drug treatments, including varenicline, transdermal nicotine (TN), bupropion and the use of a genetic test to choose between TN and bupropion. We performed Monte Carlo simulation with sensitivity analysis, informing analyses with published estimates of model parameters and current prices for genetic testing and smoking-cessation therapy. The primary outcomes were discounted life-years (LY) and lifetime tobacco-cessation treatment costs. In the base case, varenicline treatment was optimal with an ICER, compared to bupropion, of $2985/LY saved. In sensitivity analyses, varenicline was in all cases (and bupropion in most cases) admissible; only under favorable assumptions was the genetically tailored approach competitive. Our data suggest that an untailored approach of treatment with either bupropion or varenicline is a cost-effective form of tobacco dependence treatment, but a tailored approach for selecting between TN and bupropion can be cost-effective under plausible assumptions.