title: Cost-effectiveness of combinatorial pharmacogenomic testing for treatment-resistant major depressive disorder patients.
abstract: OBJECTIVE
  To describe the lifetime outcomes and economic implications of combinatorial pharmacogenomic (CPGx) testing versus treatment as usual (TAU) psychopharmacologic medication selection for a representative major depressive disorder patient who has not responded to previous treatment(s).
  
  
  METHODS
  Markov state-transition analysis based on clinical studies.
  
  
  METHODS
  Clinical validity and utility were based on published findings in prospective clinical studies of a commercially available CPGx test. Data for quality of life, direct costs, and indirect costs were extracted from meta-analyses of published literature on clinical studies and claims databases. Outcomes were assessed from a societal perspective, and included differences between the CPGx and the TAU strategies in quality-adjusted life-years (QALYs), cumulative direct and indirect costs, and cost per QALY gained.
  
  
  RESULTS
  CPGx improved the treatment response rate by 70% (1.7 times as high as that with TAU), increasing QALYs by 0.316 years. With these health benefits, CPGx is expected to save $3711 in direct medical costs per patient and $2553 in work productivity costs per patient over the lifetime. The cost-effectiveness of CPGx testing was robust over a wide range of variation in the input parameters, including the scenario when testing efficacy was set to its lower limit.
  
  
  CONCLUSIONS
  CPGx testing has been shown by prospective studies to modify treatment decisions for patients nonresponsive to previous treatment(s), with increased rates of treatment response. These effects are projected to increase quality-adjusted survival, and to save both direct and indirect costs to individual patients and society generally.
authors.affiliation: Cedar Associates LLC, 3715 Haven Ave, Ste 100, Menlo Park, CA 94025. E-mail: ujch@stanford.edu.
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.forename: Qianyi
authors.initials: Q
authors.lastname: Li
authors.forename: Bruce
authors.initials: B
authors.lastname: Quinn
mesh_terms: D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000235:genetics*; D004351:Drug Resistance; D006801:Humans; D000071185:Pharmacogenomic Testing / Q000191:economics*; D019057:Quality-Adjusted Life Years
chemical_list: D000928:Antidepressive Agents