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Economic evaluation in psychiatric pharmacogenomics: a systematic review

The Pharmacogenomics Journal volume 21, pages 533–541 (2021)Cite this article

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Abstract

Nowadays, many relevant drug–gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were cost-effective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug–gene associations and for combinatorial PGx panels, but evidence is limited for many other drug–gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.

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Fig. 1: Main pillars of the systematic review.
Fig. 2: Schematic pipeline/flowchart of the literature screening.

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Acknowledgements

This study has been partly funded by the European Union’s Horizon 2020 research and innovation grant (H2020’ 668353; Ubiquitous Pharmacogenomics) to GPP and CM and, partly funded by the European Union’s Horizon 2020 research and innovation under the Marie Skłodowska - Curie grant agreement (H2020’ 860895; TranSYS) to GPP.

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Author notes

  1. These authors contributed equally: Kariofyllis Karamperis, Maria Koromina, Panagiotis Papantoniou.

Authors and Affiliations

  1. The Golden Helix Foundation, London, UK

    Kariofyllis Karamperis, Maria Koromina & Christina Mitropoulou

  2. University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, Patras, Greece

    Kariofyllis Karamperis, Maria Koromina, Filippos Kanellakis & George P. Patrinos

  3. Warwick Business School, Coventry, UK

    Panagiotis Papantoniou

  4. Patras General University Hospital, Psychiatric Clinic, Patras, Greece

    Maria Skokou

  5. University of Athens, School of Medicine, Athens, Greece

    Konstantinos Mitropoulos

  6. University of Piraeus, Economics Department, Piraeus, Greece

    Athanassios Vozikis

  7. Institute of Medical Science, University of Toronto, Toronto, Canada

    Daniel J. Müller

  8. Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada

    Daniel J. Müller

  9. Department of Psychiatry, University of Toronto, Toronto, Canada

    Daniel J. Müller

  10. United Arab Emirates University, College of Medicine and Health Sciences, Department of Pathology, Al-Ain, UAE

    George P. Patrinos

  11. United Arab Emirates University, Zayed Center of Health Sciences, Al-Ain, UAE

    George P. Patrinos

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Correspondence to Christina Mitropoulou.

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The authors declare no competing interests. GPP is Full Member and national Representative of the European Medicines Agency, Committee for Human medicinal Product (CHMP) – Pharmacogenomics Working Party (Amsterdam, the Netherlands) and member of the Clinical Pharmacogenetics Implementation Consortium (CPIC). DJM is a member of CPIC and co-investigator in two pharmacogenetic studies where genetic test kits were provided as in-kind contribution by Myriad Neuroscience. No payment or any equity, stocks, or options from any pharmacogenetic testing company was obtained.

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Karamperis, K., Koromina, M., Papantoniou, P. et al. Economic evaluation in psychiatric pharmacogenomics: a systematic review. Pharmacogenomics J 21, 533–541 (2021). https://doi.org/10.1038/s41397-021-00249-1

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