Welton Nicky J, Johnstone Elaine C, David Sean P, Munafò Marcus R
Primary Care, Department, Community Based Medicine, University of Bristol, Bristol, UK.
Nicotine Tob Res. 2008 Jan;10(1):231-40. doi: 10.1080/14622200701767761.
We conducted a cost-effectiveness analysis of genetic testing for smoking cessation, based on data available from the published pharmacogenetic studies of nicotine replacement therapy and bupropion, and a previous cost-effectiveness analysis of smoking cessation treatments. We use multiparameter evidence synthesis methods to combine evidence on cessation by genotype with evidence on cessation irrespective of genotype (which can be written as a function of genotype-specific parameters). Our intention was to explore the most cost-effective approach to prescribing smoking cessation pharmacotherapy, given the hypothetical availability of a test based on a single-gene variant that has been reported to predict treatment response. We considered four types of treatment: nicotine replacement therapy (NRT) pharmacotherapy, bupropion SR pharmacotherapy, combination NRT and bupropion, and standard care as the control. Two scenarios were investigated, one in which the control represented brief advice and the other in which the control represented individual counseling. Strategies that either do not test for dopamine D2 receptor (DRD2) genotype (each individual receives the same treatment), or do test for DRD2 genotype (treatment allocated according to genotype), were evaluated. Our results indicated that the most cost-effective strategy in our hypothetical example of a single-gene test to aid prescription of smoking cessation pharmacotherapy is to prescribe both NRT and bupropion regardless of genotype, as a first-line treatment for smoking cessation. We conclude that it should not be assumed that genetic tailoring will necessarily be more cost-effective than applying the current "one-size-fits-all" model of pharmacotherapy for smoking cessation. In addition, single-gene tests are unlikely to be cost-effective, partly because the predictive value of these tests is likely to be modest.
我们基于已发表的尼古丁替代疗法和安非他酮的药物遗传学研究数据以及先前戒烟治疗的成本效益分析，对戒烟基因检测进行了成本效益分析。我们使用多参数证据综合方法，将按基因型的戒烟证据与不考虑基因型的戒烟证据（可表示为基因型特异性参数的函数）相结合。我们的目的是探讨在假设存在基于单一基因变异的检测方法（据报道该变异可预测治疗反应）的情况下，最具成本效益的戒烟药物治疗处方方法。我们考虑了四种治疗类型：尼古丁替代疗法（NRT）药物治疗、安非他酮缓释片药物治疗、NRT与安非他酮联合治疗以及标准护理作为对照。研究了两种情况，一种情况是对照代表简短建议，另一种情况是对照代表个体咨询。评估了不检测多巴胺D2受体（DRD2）基因型的策略（每个个体接受相同治疗）以及检测DRD2基因型的策略（根据基因型分配治疗）。我们的结果表明，在我们假设的用于辅助戒烟药物治疗处方的单基因检测示例中，最具成本效益的策略是无论基因型如何，都将NRT和安非他酮作为戒烟的一线治疗药物。我们得出结论，不应假定基因定制必然比应用当前戒烟药物治疗的“一刀切”模式更具成本效益。此外，单基因检测不太可能具有成本效益，部分原因是这些检测的预测价值可能有限。
