A cost-effectiveness analysis of genetic testing of the DRD2 Taq1A polymorphism to aid treatment choice for smoking cessation.
A cost-effectiveness analysis of genetic testing of the DRD2 Taq1A polymorphism to aid treatment choice for smoking cessation.
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DRD2 Taq1A 多态性基因检测的成本效益分析，以帮助选择戒烟治疗。
DOI：
10.1080/14622200701767761
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Munafò,MarcusR
中科院分区：
文献类型：
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作者：
Welton,NickyJ;Johnstone,ElaineC;David,SeanP;Munafò,MarcusR
我们进行了一项戒烟基因检测的成本效益分析，基于已发表的尼古丁替代疗法和安非他酮的药物遗传学研究的数据，以及先前对戒烟治疗的成本效益分析。我们使用多参数的证据合成方法结合联合收割机的证据停止基因型与证据停止基因型无关（这可以写为基因型的特定参数的函数）。我们的目的是探索最具成本效益的方法来处方戒烟药物治疗，假设有一种基于单基因变异的检测方法可以预测治疗反应。我们考虑了四种类型的治疗：尼古丁替代疗法（NRT）药物治疗，安非他酮SR药物治疗，NRT和安非他酮联合治疗，标准治疗作为对照。两种情况进行了调查，其中一个控制代表简短的建议，另一个控制代表个人咨询。对不检测多巴胺D2受体（DRD2）基因型（每个个体接受相同的治疗）或检测DRD2基因型（根据基因型分配治疗）的策略进行了评价。我们的研究结果表明，在我们假设的单基因检测的例子中，最具成本效益的策略，以帮助处方戒烟药物治疗是开NRT和安非他酮，无论基因型，作为一线治疗戒烟。我们的结论是，它不应该被假定为基因剪裁一定会比应用当前的“一刀切”的戒烟药物治疗模式更具成本效益。此外，单基因检测不太可能具有成本效益，部分原因是这些检测的预测价值可能不高。
We conducted a cost-effectiveness analysis of genetic testing for smoking cessation, based on data available from the published pharmacogenetic studies of nicotine replacement therapy and bupropion, and a previous cost-effectiveness analysis of smoking cessation treatments. We use multiparameter evidence synthesis methods to combine evidence on cessation by genotype with evidence on cessation irrespective of genotype (which can be written as a function of genotype-specific parameters). Our intention was to explore the most cost-effective approach to prescribing smoking cessation pharmacotherapy, given the hypothetical availability of a test based on a single-gene variant that has been reported to predict treatment response. We considered four types of treatment: nicotine replacement therapy (NRT) pharmacotherapy, bupropion SR pharmacotherapy, combination NRT and bupropion, and standard care as the control. Two scenarios were investigated, one in which the control represented brief advice and the other in which the control represented individual counseling. Strategies that either do not test for dopamine D2 receptor (DRD2) genotype (each individual receives the same treatment), or do test forDRD2genotype (treatment allocated according to genotype), were evaluated. Our results indicated that the most cost-effective strategy in our hypothetical example of a single-gene test to aid prescription of smoking cessation pharmacotherapy is to prescribe both NRT and bupropion regardless of genotype, as a first-line treatment for smoking cessation. We conclude that it should not be assumed that genetic tailoring will necessarily be more cost-effective than applying the current “one-size-fits-all” model of pharmacotherapy for smoking cessation. In addition, single-gene tests are unlikely to be cost-effective, partly because the predictive value of these tests is likely to be modest.