Ανάλυση κόστους της εξατομικευμένης θεραπείας μετά από γενετικό τεστ σε ψυχιατρικούς ασθενείς
Cost analysis of personalized treatment after genotyping in psychiatric patients
View/
Keywords
Pharmacogenetics ; Genetic test ; Major depressive disorder ; Cost of illness ; Illness burden ; Health care expenditures ; Personalized medicine ; Pharmacoeconomics ; Cost savings ; Health care reduction ; Cytochrome P450 ; PsychotropicAbstract
Background: Economic evaluation in genomic medicine is an emerging discipline to assess the cost–effectiveness of genome-guided treatment. This is a single center study using real world data of patients with Major Depressive Disorder who were either genotyped to follow a pharmacogenomic (PGx) guided treatment or received standard therapy without undergoing the genetic test.
Methods: The Laboratory of Pharmacogenomics and Individualized Therapy, of the University of Patras, Department of Pharmacy, in cooperation with the Psychiatric Clinic of the General University Hospital of Patras, recruited adult patients (>18 years old) diagnosed for Major Depressive Disorder (MDD) in a multicenter study. The objective of this study was to analyze a small sample of the study in Patras, with the estimation of the economic impact for standard therapy and pharmacogenetic-guided treatment for MDD, the comparison of the alternative treatments and the evaluation of the cost of illness and ADRs in each approach.
Results: A total of 62 patients were included in this study. The mean age of the patients in the intervention arm was 47,96 years, the mean BMI was 26,2 Kg/m2, 13 were male and 15 female. In the control arm, the mean age of the patients was 53 years, the mean BMI was 26,76 Kg/m2 , 8 patients were male and 26 were female. The retail price of genetic testing was calculated at €198,46, the pharmaceutical expenditures per month were €17,66 per patient for the intervention arm and €17,47 for the control arm and other direct non pharmacy costs included the outpatient monitoring and the hospitalization cost, which were translated into €16,35 and €9,80 on monthly average for the intervention and the control arm, respectively. No notable cost differences were reported, except for males in the control arm who consumed 108,04% more depression-related pharmaceutical medications compared with the males in the intervention arm. On the other hand, females in the intervention group consumed 49,96% more pharmaceutical medications compared with the females in the control group. 44,92% of the total cost for pharmaceutical regimen was consumed for baseline therapy in the intervention arm versus 52,47% in the control arm, while antipsychotics represented the higher costs among all comorbid regimens. None of the patients in both arms had moderate or severe ADRs, precluding the evaluation of effectiveness.
Conclusions: The current study, although it was impossible to evaluate the effectiveness of the genome-guided pharmaceutical treatment due to the small sample examined, is nevertheless the first attempt to calculate the cost of genome-guided treatment in psychiatric patients in Greece compared with the conventional treatment prescribed to patients with mental illnesses. Comparison of the intervention and control arm represented similar treatment costs. All costs and their respective percentage of participation in the total cost were identified and analyzed based on various factors, such as the age of the patients and the drugs prescribed.
A study of a bigger sample examined is expected to confirm that, as in cardiology and oncology, personalized treatment after genotyping helps towards the reduction of ADRs and the relevant health care costs in psychiatric patients.