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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Vydáno v:The world journal of biological psychiatry Ročník 12; číslo 7; s. 501 - 515
Hlavní autoři: Serretti, Alessandro, Olgiati, Paolo, Bajo, Emanuele, Bigelli, Marco, De Ronchi, Diana
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Informa Healthcare 01.10.2011
Taylor & Francis
Témata:
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
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Abstract 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.
AbstractList To evaluate the benefit of pharmacogenetics in antidepressant treatment.OBJECTIVETo evaluate the benefit of pharmacogenetics in antidepressant treatment.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).METHODSIn 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).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.RESULTSUnder 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.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.CONCLUSIONNotwithstanding 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.
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.
To evaluate the benefit of pharmacogenetics in antidepressant treatment. 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). 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. 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.
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.
Author De Ronchi, Diana
Serretti, Alessandro
Olgiati, Paolo
Bajo, Emanuele
Bigelli, Marco
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  surname: Serretti
  fullname: Serretti, Alessandro
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  organization: Institute of Psychiatry, University of Bologna
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  givenname: Paolo
  surname: Olgiati
  fullname: Olgiati, Paolo
  email: alessandro.serretti@unibo.it, alessandro.serretti@unibo.it
  organization: Institute of Psychiatry, University of Bologna
– sequence: 3
  givenname: Emanuele
  surname: Bajo
  fullname: Bajo, Emanuele
  email: alessandro.serretti@unibo.it, alessandro.serretti@unibo.it
  organization: Department of Management, University of Bologna
– sequence: 4
  givenname: Marco
  surname: Bigelli
  fullname: Bigelli, Marco
  email: alessandro.serretti@unibo.it, alessandro.serretti@unibo.it
  organization: Department of Management, University of Bologna
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  givenname: Diana
  surname: De Ronchi
  fullname: De Ronchi, Diana
  email: alessandro.serretti@unibo.it, alessandro.serretti@unibo.it
  organization: Institute of Psychiatry, University of Bologna
BackLink https://www.ncbi.nlm.nih.gov/pubmed/21595526$$D View this record in MEDLINE/PubMed
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SSID ssj0037991
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Snippet Abstract Objective. To evaluate the benefit of pharmacogenetics in antidepressant treatment. Methods. In a simulated trial 100,000 subjects in a current...
Objective. To evaluate the benefit of pharmacogenetics in antidepressant treatment. Methods. In a simulated trial 100,000 subjects in a current episode of...
To evaluate the benefit of pharmacogenetics in antidepressant treatment. In a simulated trial 100,000 subjects in a current episode of major depressive...
To evaluate the benefit of pharmacogenetics in antidepressant treatment.OBJECTIVETo evaluate the benefit of pharmacogenetics in antidepressant treatment.In a...
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pubmed
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StartPage 501
SubjectTerms 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
Title A model to incorporate genetic testing (5-HTTLPR) in pharmacological treatment of major depressive disorders
URI https://www.tandfonline.com/doi/abs/10.3109/15622975.2011.572998
https://www.ncbi.nlm.nih.gov/pubmed/21595526
https://www.proquest.com/docview/900640788
Volume 12
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