October 26, 2020
Preemptive pharmacogenomic panel testing is cost-effective for cardiovascular disease management for a population 45 to 64 years old at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY), according to a study published online in Genetics in Medicine.
“Given its potential for long-term cost-effectiveness as documented in our study, health-care payers might consider rolling out preemptive pharmacogenomic panel testing in a system-wide manner with efforts from multiple expertise areas,” wrote Mayo Clinic researchers.
The finding stemmed from a decision analytic model for a hypothetical cohort of 10,000 patients, ages 45 and older, that compared the cost-effectiveness of preemptive pharmacogenomic panel testing, reactive pharmacogenomic panel testing, and usual care (no testing) in cardiovascular disease management from a US payer’s perspective. The following gene-drug pairs were included in the testing panel: CYP2C19–clopidogrel, CYP2C9/VKORC1–warfarin, and SLCO1B1–statins with 30 test-return days.
Compared with usual care, preemptive testing resulted in an average 0.35 additional QALYs for each person and yielded an incremental cost-effectiveness ratio (ICER) of $86,227 per QALY, according to the study, suggesting its cost-effectiveness. However, further analysis indicated preemptive testing benefited patients ages 45 to 64 and was not cost-effective when applied to populations older than 65.
Compared with usual care, reactive testing resulted in an average increase of 0.09 QALYs per person and an ICER of $148,726 per QALY and, therefore, was not considered cost-effective at a willingness-to-pay threshold of $100,000 per QALY.
“Third, while comparing preemptive and reactive strategies, preemptive testing was found to be superior to reactive testing with regard to both cost-effectiveness (lower ICER) and patient-centered outcomes (higher additional QALYs gained), when the testing was panel-based,” researchers wrote. “Therefore, if the pharmacogenomic panel testing was to be implemented, preemptive pharmacogenomic panel testing would likely be more cost-effective than reactive testing under the study assumptions.”
Zhu Y, Moriarty JP, Swanson KM, et al. A model-based cost-effectiveness analysis of pharmacogenomic panel testing in cardiovascular disease management: preemptive, reactive, or none? [published online ahead of print, 2020 Oct 12]. Genet Med. 2020;10.1038/s41436-020-00995-w. doi:10.1038/s41436-020-00995-w