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Pharmacogenetic-guided glimepiride therapy in type-2 diabetes mellitus: a cost-effectiveness study

The Pharmacogenomics Journal volume 21, pages 559–565 (2021)Cite this article

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Abstract

The demonstration of the link between certain genetic variations and drug response has allowed the emergence of pharmacogenetics, which offers many opportunities to improve patient care. Type-2 diabetes mellitus is a disease for which several gene polymorphisms have been reported to be associated with drug response. Sulfonylureas are commonly used for the management of this disease. Genetic polymorphisms of CYP2C9, the main enzyme involved in the metabolism of sulfonylureas, have been associated with the risk of severe hypoglycaemia, particularly in poor metabolizers carrying CYP2C9 *3/*3 genotype, and especially in the case of patients treated with glimepiride. The objectives of the present study were to evaluate the potential clinical and economic outcomes of using CYP2C9 genotype data to guide the management of SU regimen in patients initiating glimepiride therapy, and to identify factors affecting the cost-effectiveness of this treatment scheme. The analysis was conducted using a decision tree, considering a 1-year time horizon, and taking as perspective that of the French national health insurance system. With pharmacogenetic-guided therapy, the cost to avoid an episode of severe hypoglycaemia event per 100 000 patients treated was €421 834. Genotyping cost was the most influential factor on the incremental cost-effectiveness ratio. In conclusion, the potential cost of CYP2C9 genotype-guided dosing for glimepiride therapy is relatively high, and associated with modest improvements with respect to the number of hypoglycaemia avoided, as compared with standard dosing. Additional economic studies are required to better specify the usefulness of CYP2C9 genotyping prior to glimepiride regimen initiation.

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Acknowledgements

The authors thank Dr. Myriam Moret and Dr. Michel Bensimon for help in the obtention of the clinical parameters of the study. The authors also thank Philip Robinson and Verena Landel (DRCI, Hospices Civils de Lyon) for help in manuscript preparation.

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Authors and Affiliations

  1. Groupement Hospitalier Nord, Service de Pharmacie, Hospices Civils de Lyon, Lyon, France

    Cécile Fokoun, Sylvain Goutelle, Michel Tod & Laurent Bourguignon

  2. Pôle de santé publique, Service d’évaluation économique en santé, Hospices Civils de Lyon, Lyon, France

    Hassan Serrier & Hugo Rabier

  3. Cellule Innovation, Département de la recherche clinique et de l’innovation, Hospices Civils de Lyon, Lyon, France

    Hassan Serrier

  4. HESPER Lab, EA 7425, Université Claude Bernard Lyon I, Lyon, France

    Hugo Rabier

  5. Laboratoire de Biométrie et Biologie Evolutive (LBBE), équipe EMET (Evaluation et Modélisation des Effets thérapeutiques), UMR CNRS 5558, Université Claude Bernard Lyon I, Lyon, France

    Sylvain Goutelle, Michel Tod & Laurent Bourguignon

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  1. Cécile Fokoun
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Correspondence to Cécile Fokoun.

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Fokoun, C., Serrier, H., Rabier, H. et al. Pharmacogenetic-guided glimepiride therapy in type-2 diabetes mellitus: a cost-effectiveness study. Pharmacogenomics J 21, 559–565 (2021). https://doi.org/10.1038/s41397-021-00232-w

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