Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model.
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.
Perlis
Roy H
RH
Pharmacogenomics Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. rperlis@partners.org
Ganz
David A
DA
Avorn
Jerry
J
Schneeweiss
Sebastian
S
Glynn
Robert J
RJ
Smoller
Jordan W
JW
Wang
Philip S
PS
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*
D014150:Antipsychotic Agents; D003024:Clozapine