What is the cost-effectiveness of pharmacogenetic (pharmacogenomics) testing in psychiatry?

From the Guidelines

To effectively present the cost effectiveness of pharmacogenetic testing in psychiatry, prioritize gathering data on both the costs and benefits of testing, focusing on how it improves patient outcomes and reduces healthcare expenditures, as supported by the most recent study 1. When assembling information for the presentation, it's crucial to start with an overview of pharmacogenetic testing, explaining its role in identifying genetic variations that affect medication metabolism and response, particularly in the context of CYP450 enzymes that metabolize common psychiatric medications like SSRIs, SNRIs, and antipsychotics.

• Include specific examples such as CYP2D6 testing for fluoxetine or CYP2C19 for escitalopram, highlighting their relevance to psychiatric practice.
• Collect data on direct testing costs, which typically range from $300 to $1200 per test, and compare this to the costs associated with trial-and-error prescribing, including expenses from ineffective treatments, adverse reactions, hospitalizations, and extended disability.
• Present real-world outcomes data showing reduced healthcare utilization, fewer medication switches, and improved medication adherence in patients who received testing, as these metrics are critical for assessing cost effectiveness.
• Incorporate time-to-efficacy improvements and quality of life metrics to provide a comprehensive view of the benefits of pharmacogenetic testing.
• Calculate potential cost savings using models that factor in reduced hospitalizations, emergency visits, and work productivity improvements, ensuring that the analysis is grounded in economic reality.
• Address limitations by discussing which patient populations benefit most from testing, such as those with treatment resistance or medication sensitivities, to tailor the presentation to the most relevant clinical scenarios. The most recent study 1 from 2022 provides valuable insights into advancing pharmacogenomics from single-gene to preemptive testing, emphasizing the cost-effectiveness and potential long-term savings of implementing pharmacogenetic testing in psychiatric practice.
• This study highlights the benefits of preemptive testing, including its ability to provide test results already available in the electronic health record at the time of prescribing, thereby facilitating more informed decision-making.
• The cost of preemptive testing is noted to be approximately equivalent to the cost of two single-gene tests and can provide cost savings over years with continued use of genetic information for medication use, as discussed in the context of 1. By prioritizing the most recent and highest quality evidence, the presentation can effectively argue for the integration of pharmacogenetic testing into psychiatric practice, emphasizing its potential to improve patient outcomes while reducing healthcare expenditures.

From the Research

Cost Effectiveness of Pharmacogenetic Testing in Psychiatry

• The cost effectiveness of pharmacogenetic testing in psychiatry is a topic of ongoing research, with studies suggesting that it may be a valuable tool in guiding medication selection 2, 3.
• A systematic review of cost-effectiveness analyses of pharmacogenomic interventions found that the majority of studies reported a favorable cost-effectiveness ratio for the pharmacogenomic-based strategy, although the quality of the evidence was generally low 3.
• Another study found that knowledge of the pharmacology of antidepressants and antipsychotics can yield results comparable to pharmacogenetic testing, suggesting that the cost effectiveness of testing may depend on the specific context and patient population 4.

Key Considerations for Cost-Effectiveness Analyses

• Cost-effectiveness analyses should be built on well-researched and robust inputs for costs and outcomes, and may be modeled using techniques such as Markov chain models 5.
• These analyses should be investigated from multiple perspectives, including society and healthcare payers, and limitations should be clearly stated 5.
• The quality of the evidence should be assessed using standardized criteria, such as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group criteria 6.

Evidence for Pharmacogenetic Testing in Psychiatry

• A systematic review of the Assurex GeneSight Psychotropic test found that patients who received the test to guide psychotropic medication selection had improved response to depression treatment and greater patient and clinician satisfaction compared to those who received treatment as usual 6.
• However, the quality of the evidence was generally low, and there is uncertainty about the use of GeneSight to guide medication selection in patients with anxiety or schizophrenia 6.
• Further research is needed to fully understand the cost effectiveness of pharmacogenetic testing in psychiatry and to guide its use in clinical practice 2, 3, 6.