title: Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1 year prospective evaluation.
abstract: OBJECTIVE
  The objective of this project was to determine pharmacy cost savings and improvement in adherence based on a combinatorial pharmacogenomic test (CPGx ) in patients who had switched or added a new psychiatric medication after having failed monotherapy for their psychiatric disorder.
  
  
  METHODS
  The prospective project compared 1 year pharmacy claims between a GeneSight CPGx guided cohort and a propensity-matched control group. Patients were project eligible if they augmented or switched to a different antidepressant or antipsychotic medication within the previous 90 days. Following the medication switch or augmentation, pharmacogenomic (PGx) testing was offered to each patient's treating clinician. Pharmacy claims were extracted from the Medco pharmacy claims database for each patient (n = 2168) for 1 year following testing and compared to a 5-to-1 propensity-matched treatment as usual (TAU), standard of care control group (n = 10,880).
  
  
  METHODS
  Total pharmacy spend per member per year; adherence.
  
  
  RESULTS
  Patients who received PGx testing saved $1035.60 in total medication costs (both CNS and non-CNS medications) over 1 year compared to the non-tested standard of care cohort (p = 0.007). PGx testing improved adherence compared to standard of care (ΔPDCCPGx = 0.11 vs ΔPDCTAU = -0.01; p < 0.0001). Pharmacy cost savings averaged $2774.53 for patients who were changed to a CPGx congruent medication regimen, compared to those who were not (p < 0.0001).
  
  
  CONCLUSIONS
  PGx testing provides significant 'real world' cost savings, while simultaneously improving adherence in a difficult to treat psychiatric population. Limitations of this study include the lack of therapeutic efficacy follow-up data and possible confounding due to matching only on demographic and psychiatric variables.
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Winner
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Carhart
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Altar
authors.affiliation: b b Express Scripts , St. Louis , MO , USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Goldfarb
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Allen
authors.affiliation: b b Express Scripts , St. Louis , MO , USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Lavezzari
authors.affiliation: b b Express Scripts , St. Louis , MO , USA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Parsons
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Marshak
authors.affiliation: b b Express Scripts , St. Louis , MO , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Garavaglia
authors.affiliation: a a Assurex Health , Mason , OH , USA.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Dechairo
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D005252:Fees, Pharmaceutical / Q000706:statistics & numerical data; D005260:Female; D005820:Genetic Testing / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010597:Pharmacogenetics / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Adherence; Combinatorial pharmacogenomic testing; Mental health; Pharmacogenomics; Pharmacy spend