Prioritizing pharmacogenetic research: a value of information analysis of CYP2D6 testing to guide breast cancer treatment.
Prioritizing pharmacogenetic research: a value of information analysis of CYP2D6 testing to guide breast cancer treatment.
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优先考虑药物遗传学研究：CYP2D6 检测信息分析对指导乳腺癌治疗的价值。
DOI：
10.1016/j.jval.2011.05.048
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Hawkins,Neil
中科院分区：
文献类型：
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作者：
Woods,Beth;Veenstra,David;Hawkins,Neil
ObjectiveTo demonstrate how value of information（VOI）analysis can be used to establish research priorities about the use of pharmacogenetic tests using CYP 2D 6 testing to select adjuvant hormonal therapy in early stage breast cancer as a case study. Methods以下四种治疗途径进行了比较在马尔可夫模型：他莫昔芬治疗; CYP 2D 6 test and treat homozygous and heterozygous wild type patients（wt/wt; wt/*4）与他莫昔芬和 *4/*4患者与阿那曲唑（HetTam）; CYP 2D 6测试和治疗纯合子野生型患者与他莫昔芬和其他与阿那曲唑（HomTam）;和阿那曲唑治疗。药物遗传学测试的疗效估计通过合成随机对照试验数据比较他莫昔芬阿那曲唑与观察数据linkingCYP 2D 6基因型tamoxifen outcomes.ResultsIn order的有效性增加的比较者是他莫昔芬，HetTam，HomTam，阿那曲唑。测试和治疗策略的健康结果是高度不确定的。比较成本的差异取决于对阿那曲唑专利有效期的假设。根据专利到期假设和可接受的成本效益阈值，联合王国在完全信息情况下作出决定的预期价值为6，900万英镑至1.06亿英镑。最有价值的研究（VOI 5300万-8200万英镑）阐明了CYP 2D 6基因型与他莫昔芬有效性之间的关系。这是不确定的其他研究设计的价值是否会超过其costs.ConclusionsRetrospective分析的大型辅助芳香化酶抑制剂试验之一，以更好地了解任何关联betweenCYP 2D 6基因型和他莫昔芬的结果。VOI方法可能有助于确定证据需求的优先顺序并通过药物遗传学证据开发协议构建覆盖范围。
ObjectivesTo demonstrate how value of information (VOI) analysis can be used to establish research priorities regarding the use of pharmacogenetic tests usingCYP2D6testing to select adjuvant hormonal therapy in early stage breast cancer as a case study.MethodsThe following four treatment pathways are compared in a Markov model: tamoxifen treatment;CYP2D6test and treat homozygous and heterozygous wild type patients (wt/wt; wt/*4) with tamoxifen and *4/*4 patients with anastrozole (HetTam);CYP2D6test and treat homozygous wild type patients with tamoxifen and others with anastrozole (HomTam); and anastrozole treatment. Pharmacogenetic testing efficacy is estimated by synthesizing randomized controlled trial data comparing tamoxifen to anastrozole with observational data linkingCYP2D6genotype to tamoxifen outcomes.ResultsIn order of increasing effectiveness the comparators are tamoxifen, HetTam, HomTam, anastrozole. Health outcomes for test and treatment strategies are highly uncertain. Differences in comparator costs depend on assumptions made regarding anastrozole patent expiry. The expected value of a decision taken with perfect information is £69 to £106 million (pound sterling) for the United Kingdom depending on patent expiry assumptions and the acceptable cost-effectiveness threshold. The most valuable research (VOI £53–£82 million) elucidates the relationship betweenCYP2D6genotype and tamoxifen effectiveness. It is uncertain whether values of other research designs would exceed their costs.ConclusionsRetrospective analysis of one of the large adjuvant aromatase inhibitor trials is warranted to better understand any association betweenCYP2D6genotype and tamoxifen outcomes. VOI approaches may be helpful for prioritising evidence needs and structuring coverage with evidence development agreements for pharmacogenetics.