A model to incorporate genetic testing (5-HTTLPR) in pharmacological treatment of major depressive disorders

Abstract Objective. To evaluate the benefit of pharmacogenetics in antidepressant treatment. Methods. In a simulated trial 100,000 subjects in a current episode of major depressive disorder (MDD) received citalopram or bupropion based on the clinician's decision (algorithm A) or following indic...

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Published in:The world journal of biological psychiatry Vol. 12; no. 7; pp. 501 - 515
Main Authors: Serretti, Alessandro, Olgiati, Paolo, Bajo, Emanuele, Bigelli, Marco, De Ronchi, Diana
Format: Journal Article
Language:English
Published: England Informa Healthcare 01.10.2011
Taylor & Francis
Subjects:
antidepressants
Antidepressive Agents - economics
Antidepressive Agents - therapeutic use
Bupropion - economics
Bupropion - therapeutic use
Citalopram - economics
Citalopram - therapeutic use
Computer Simulation
cost-benefit
Cost-Benefit Analysis - methods
Depression
Depressive Disorder, Major - drug therapy
Depressive Disorder, Major - economics
Depressive Disorder, Major - genetics
Genetic Testing - economics
Humans
Meta-Analysis as Topic
Models, Psychological
pharmacoeconomics
pharmacogenetics
Pharmacogenetics - economics
Pharmacogenetics - methods
Serotonin Plasma Membrane Transport Proteins
ISSN:1562-2975, 1814-1412, 1814-1412
Online Access:Get full text
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Summary:Abstract Objective. To evaluate the benefit of pharmacogenetics in antidepressant treatment. Methods. In a simulated trial 100,000 subjects in a current episode of major depressive disorder (MDD) received citalopram or bupropion based on the clinician's decision (algorithm A) or following indications from 5-HTTLPR genetic testing (algorithm B), which effect size of was estimated from a meta-analysis of pharmacogenetic trials. A and B were compared in a cost-utility analysis (12 weeks). Costs (international $, 2010) were drawn from official sources. Treatment effects were expressed as quality-adjusted life weeks (QALWs). Outcome was incremental cost-effectiveness ratio (ICER). Results. Under base-case conditions, genetic test use was associated with increases in antidepressant response (0.062 QALWs) and tolerability (0.016 QALWs) but cost benefit was not acceptable (ICER = $2,890; $1,800-$4,091). However, when the joint effect on antidepressant response and tolerability was analyzed in two recurrent episodes, ICER dropped to $1,392 ($837-$1,982). Cost-effectiveness acceptability curve (CEAC) showed a >80% probability that ICER value fell below the commonly accepted 3 times Gross Domestic Product (GDP) threshold (World Health Organization) and therefore suggesting cost-effectiveness. Conclusion. Notwithstanding some caveats (exclusion of gene-gene and gene-environment interactions; simple 5-HTTLPR architecture), this simulation is favourable to incorporate pharmacogenetic test in antidepressant treatment.
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ISSN:1562-2975
1814-1412
1814-1412
DOI:10.3109/15622975.2011.572998