When is pharmacogenetic testing for antidepressant response ready for the clinic? A cost-effectiveness analysis based on data from the STAR*D study.
When is pharmacogenetic testing for antidepressant response ready for the clinic? A cost-effectiveness analysis based on data from the STAR*D study.
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DOI：
10.1038/npp.2009.50
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发表时间：
2009-09
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--
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个性化医疗改变情绪障碍治疗的潜力在精神病学中得到了广泛的吹捧，但尚未量化。我们从社会的角度评估了一个假定的药物遗传学试验在治疗重性抑郁症（MDD）中抗抑郁反应的成本和效益。具体而言，我们使用状态转移概率模型进行了成本-效果分析，该模型结合了MDD的多中心星星 *D有效性研究的概率。比较了序贯抗抑郁药试验的成本和质量调整生命年，有或没有对选择性5-羟色胺再摄取抑制剂（SSRIs）的差异反应的药物遗传学试验的指导。可能的SSRI应答者接受SSRI，而可能的无应答者接受去甲肾上腺素/多巴胺再摄取抑制剂安非他酮。对于40岁的重度抑郁症患者，与首先使用SSRI治疗所有患者并在未缓解的情况下依次转换相比，应用药物遗传学测试并使用非SSRI安非他酮治疗无应答风险较高的患者每增加质量调整生命年（QALY）成本为93，520美元。对于缓解率比低至1.5的检测，成本/QALY降至50，000美元以下，相当于比值比约1.8-2.0。因此，在某些情况下，对不同抗抑郁反应的测试可能具有成本效益。这些情况，特别是替代治疗策略和测试效应量的可用性，可以估计，并应在这些测试广泛应用于临床环境之前加以考虑。
The potential of personalized medicine to transform the treatment of mood disorders has been widely touted in psychiatry, but has not been quantified. We estimated the costs and benefits of a putative pharmacogenetic test for antidepressant response in the treatment of major depressive disorder (MDD) from the societal perspective. Specifically, we performed cost-effectiveness analyses using state-transition probability models incorporating probabilities from the multicenter STAR*D effectiveness study of MDD. Costs and quality-adjusted life years were compared for sequential antidepressant trials, with or without guidance from a pharmacogenetic test for differential response to selective serotonin reuptake inhibitors (SSRIs). Likely SSRI responders received an SSRI, while likely nonresponders received the norepinephrine/dopamine reuptake inhibitor bupropion. For a 40-year-old with major depressive disorder, applying the pharmacogenetic test and using the non-SSRI bupropion for those at higher risk for nonresponse cost $93,520 per additional quality-adjusted life-year (QALY) compared with treating all patients with an SSRI first and switching sequentially in the case of nonremission. Cost/QALY dropped below $50,000 for tests with remission rate ratios as low as 1.5, corresponding to odds ratios ~1.8–2.0. Tests for differential antidepressant response could thus become cost-effective under certain circumstances. These circumstances, particularly availability of alternative treatment strategies and test effect sizes, can be estimated and should be considered before these tests are broadly applied in clinical settings.
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影响因子：
3.5
作者：
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