Original Article

A cost-effectiveness analysis of maternal CYP2D6 genetic testing to guide treatment for postpartum pain and avert infant adverse events

Received:
Revised:
Accepted:
Published online:

Abstract

Mothers with a CYP2D6 ultrarapid metabolizer phenotype may expose their infants to risk of adverse events when taking codeine while breastfeeding, by producing more of the active metabolite, morphine. Pharmacogenetic testing may be a valuable tool to identify such mothers, but testing can be costly. The objective of the study was to determine the incremental costs of genotyping to avert neonatal adverse events during maternal pharmacotherapy. A cost-effectiveness analysis, using a decision model, was performed with a hypothetical cohort of prenatal subjects. Parameter estimates, costs and ranges for sensitivity analyses were ascertained from the literature and expert opinion. Sensitivity analyses were conducted to assess the robustness of the results. Probabilistic sensitivity analysis revealed an incremental cost-effectiveness (ICER) of $10 433 (Canadian dollars) for genotyping compared to no genotyping per adverse event averted. Results were sensitive to hospital admission costs. The ICER was lower when evaluating only subjects having caesarean deliveries or those from ethnic populations known to have a high prevalence of ultra-rapid metabolizers. Although genotyping to guide pharmacotherapy was not cost saving, the cost to avert an infant adverse event may represent good value for money in specific populations. With a growing demand for personalized medicine, these findings are relevant for decision makers, clinicians and patients.

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Acknowledgements

This work was supported by scholarships from the Ontario Student Opportunity Trust Fund – Hospital for Sick Children Foundation Student Scholarship Program, the Ontario Graduate Scholarship Program, the Institute of Health Policy, Management and Evaluation and the Canadian Federation of University Women.

Author contributions

MEM, HB, GK, SI, WJU designed the research. MEM, DFL performed the research and analyzed the data. MEM, WJU wrote the paper. MEM, DFL performed the research and analyzed the data. MEM, WJU wrote the paper.

Author information

Affiliations

  1. Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada

    • M E Moretti
  2. Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada

    • M E Moretti
    • , H Berger
    •  & W J Ungar
  3. Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada

    • D F Lato
    • , G Koren
    •  & S Ito
  4. Maternal Fetal Medicine, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada

    • H Berger
  5. The Keenan Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada

    • H Berger
  6. Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada

    • G Koren
    •  & W J Ungar
  7. Faculty of Medicine, The University of Toronto, Toronto, Ontario, Canada

    • G Koren
    •  & S Ito
  8. Translational Medicine Program, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada

    • S Ito

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to W J Ungar.