Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment
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 pu...
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Published in | The pharmacogenomics journal Vol. 8; no. 6; pp. 391 - 399 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
London
Nature Publishing Group UK
01.12.2008
Nature Publishing Group |
Subjects | |
Online Access | Get full text |
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Abstract | 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. |
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AbstractList | 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. |
Audience | Academic |
Author | Asch, D A Lerman, C Rukstalis, Margaret Patterson, Freda Heitjan, D F Ray, Riju |
AuthorAffiliation | 5 The Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, Philadelphia, PA, USA 1 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA 4 The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA 6 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA 2 The Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA 3 Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA 7 Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA |
AuthorAffiliation_xml | – name: 4 The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA – name: 2 The Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA – name: 6 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA – name: 7 Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA – name: 1 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA – name: 5 The Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, Philadelphia, PA, USA – name: 3 Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA |
Author_xml | – sequence: 1 givenname: D F surname: Heitjan fullname: Heitjan, D F email: dheitjan@mail.med.upenn.edu organization: Department of Biostatistics and Epidemiology, University of Pennsylvania, The Abramson Cancer Center, University of Pennsylvania, Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center – sequence: 2 givenname: D A surname: Asch fullname: Asch, D A organization: The Abramson Cancer Center, University of Pennsylvania, Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, The Leonard Davis Institute of Health Economics, University of Pennsylvania, The Transdisciplinary Tobacco Use Research Center, University of Pennsylvania – sequence: 3 givenname: Riju surname: Ray fullname: Ray, Riju organization: Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Department of Psychiatry, University of Pennsylvania – sequence: 4 givenname: Margaret surname: Rukstalis fullname: Rukstalis, Margaret organization: Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Department of Pharmacology, University of Pennsylvania – sequence: 5 givenname: Freda surname: Patterson fullname: Patterson, Freda organization: Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Department of Pharmacology, University of Pennsylvania – sequence: 6 givenname: C surname: Lerman fullname: Lerman, C organization: The Abramson Cancer Center, University of Pennsylvania, Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, The Leonard Davis Institute of Health Economics, University of Pennsylvania, Department of Pharmacology, University of Pennsylvania |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18347612$$D View this record in MEDLINE/PubMed |
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Snippet | We evaluated the cost-effectiveness of a range of smoking cessation drug treatments, including varenicline, transdermal nicotine (TN), bupropion and the use of... |
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SubjectTerms | 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 |
Title | Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment |
URI | http://dx.doi.org/10.1038/sj.tpj.6500492 https://link.springer.com/article/10.1038/sj.tpj.6500492 https://www.ncbi.nlm.nih.gov/pubmed/18347612 https://www.proquest.com/docview/227941664 https://www.proquest.com/docview/2641697927 https://search.proquest.com/docview/19573831 https://search.proquest.com/docview/69789009 https://pubmed.ncbi.nlm.nih.gov/PMC5618442 |
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