A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy.
PLoS One
; 11(12): e0169065, 2016.
Article
en En
| MEDLINE
| ID: mdl-28033366
ABSTRACT
OBJECTIVE:
Genotyping for CYP2D6 has the potential to predict differences in metabolism of nortriptyline. This information could optimize pharmacotherapy. We determined the costs and effects of routine genotyping for old aged Dutch depressed inpatients.METHODS:
With a decision-tree, we modelled the first 12 weeks of nortriptyline therapy. Direct costs of genotyping, hospitalization, therapeutic drug monitoring and drugs were included. Based on genotype, patients could be correctly, sub-, or supratherapeutically dosed. Improvement from sub- or supratherapeutically dosed patients to correctly dosed patients was simulated, assuming that genotyping would prevent under- or overdosing of patients. In the base case, this improvement was assumed to be 35%. A probabilistic sensitivity analysis (PSA) was performed to determine uncertainty around the incremental cost-effectiveness ratio (ICER).RESULTS:
In the base case analysis, costs for genotyping were assumed 200 per test with a corresponding ICER at 1 333 000 per QALY. To reach a 50 000 per QALY cut-off, genotyping costs should be decreased towards 40 per test. At genotyping test costs < 35 per test, genotyping was dominant. At test costs of 17 per test there was a 95% probability that genotyping was cost-effective at 50 000 per QALY.CONCLUSIONS:
CYP2D6 genotyping was not cost-effective at current genotyping costs at a 50 000 per QALY threshold, however at test costs below 40, genotyping could be costs-effective.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Análisis Costo-Beneficio
/
Citocromo P-450 CYP2D6
/
Depresión
/
Técnicas de Genotipaje
/
Nortriptilina
Tipo de estudio:
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Límite:
Humans
/
Middle aged
Idioma:
En
Revista:
PLoS One
Asunto de la revista:
CIENCIA
/
MEDICINA
Año:
2016
Tipo del documento:
Article
País de afiliación:
Países Bajos