title: Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment.
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.
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104-6021, USA. dheitjan@mail.med.upenn.edu
authors.forename: D F
authors.initials: DF
authors.lastname: Heitjan
authors.forename: D A
authors.initials: DA
authors.lastname: Asch
authors.forename: Riju
authors.initials: R
authors.lastname: Ray
authors.forename: Margaret
authors.initials: M
authors.lastname: Rukstalis
authors.forename: Freda
authors.initials: F
authors.lastname: Patterson
authors.forename: C
authors.initials: C
authors.lastname: Lerman
mesh_terms: D001552:Benzazepines / Q000008:administration & dosage / Q000494:pharmacology; D016642:Bupropion / Q000008:administration & dosage / Q000494:pharmacology; D003362:Cost-Benefit Analysis; D005838:Genotype; D006801:Humans; D010597:Pharmacogenetics; D011810:Quinoxalines / Q000008:administration & dosage / Q000494:pharmacology; D011978:Receptors, Nicotinic / Q000187:drug effects; D016540:Smoking Cessation / Q000191:economics; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D011810:Quinoxalines; D011978:Receptors, Nicotinic; D016642:Bupropion; D000068580:Varenicline