title: Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model.
abstract: Clinical application of pharmacogenetic testing has been proposed as a means of improving treatment outcomes in psychiatry. The identification of a putative genetic test for better clozapine response in schizophrenia offers an opportunity to evaluate the cost-effectiveness of such testing. The authors performed a cost-effectiveness analysis of a genetic test that may identify individuals with greater likelihood of responding to clozapine treatment. We modeled a target population of schizophrenia patients in an acute psychotic episode, using a lifetime time horizon and societal perspective. Outcome measures included life expectancy, quality-adjusted life expectancy, costs, and incremental cost-effectiveness. Effects of variations in testing parameters were also examined. For a 30-year-old with schizophrenia, applying the pharmacogenetic test and treating those predicted to respond to clozapine with clozapine-first cost US $47,705 per additional quality-adjusted life-year, compared with treating all patients with conventional agents and reserving clozapine for treatment-resistant patients. In 1-way sensitivity analyses, test sensitivity and cost had the greatest impact on the incremental cost-effectiveness. We conclude that pharmacogenetic tests may achieve utility in clinical psychiatry, although their cost-effectiveness depends on several clinical parameters. More consistent reporting of test parameters such as sensitivity and specificity would greatly facilitate assessment of future pharmacogenetic studies.
authors.affiliation: Pharmacogenomics Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. rperlis@partners.org
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Smoller
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D010597:Pharmacogenetics / Q000191:economics*; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics / Q000235:genetics*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine