Institute of Psychiatry, University of Bologna, Bologna, Italy.
World J Biol Psychiatry. 2011 Oct;12(7):501-15. doi: 10.3109/15622975.2011.572998. Epub 2011 May 19.
To evaluate the benefit of pharmacogenetics in antidepressant treatment.
In a simulated trial 100,000 subjects in a current episode of major depressive disorder (MDD) received citalopram or bupropion based on the clinician's decision (algorithm A) or following indications from 5-HTTLPR genetic testing (algorithm B), which effect size of was estimated from a meta-analysis of pharmacogenetic trials. A and B were compared in a cost-utility analysis (12 weeks). Costs (international $, 2010) were drawn from official sources. Treatment effects were expressed as quality-adjusted life weeks (QALWs). Outcome was incremental cost-effectiveness ratio (ICER).
Under base-case conditions, genetic test use was associated with increases in antidepressant response (0.062 QALWs) and tolerability (0.016 QALWs) but cost benefit was not acceptable (ICER = $2,890; $1,800-$4,091). However, when the joint effect on antidepressant response and tolerability was analyzed in two recurrent episodes, ICER dropped to $1,392 ($837-$1,982). Cost-effectiveness acceptability curve (CEAC) showed a >80% probability that ICER value fell below the commonly accepted 3 times Gross Domestic Product (GDP) threshold (World Health Organization) and therefore suggesting cost-effectiveness.
Notwithstanding some caveats (exclusion of gene-gene and gene-environment interactions; simple 5-HTTLPR architecture), this simulation is favourable to incorporate pharmacogenetic test in antidepressant treatment.
评估药物遗传学在抗抑郁治疗中的获益。
在一项模拟试验中，10 万名当前患有重度抑郁症（MDD）的患者根据临床医生的决策（算法 A）或 5-HTTLPR 基因检测结果（算法 B）接受西酞普兰或安非他酮治疗，后者的疗效大小是根据药物遗传学试验的荟萃分析估计的。在成本-效用分析（12 周）中比较了 A 和 B。成本（国际美元，2010 年）来自官方来源。治疗效果以质量调整生命周数（QALWs）表示。结果为增量成本效益比（ICER）。
在基础条件下，基因检测的使用与抗抑郁药反应（0.062 QALWs）和耐受性（0.016 QALWs）的增加有关，但成本效益不可接受（ICER = 2890 美元；1800-4091 美元）。然而，当在两个复发性发作中分析对抗抑郁反应和耐受性的联合影响时，ICER 降至 1392 美元（837-1982 美元）。成本效益可接受性曲线（CEAC）显示，ICER 值低于普遍接受的 3 倍国内生产总值（GDP）阈值（世界卫生组织）的可能性大于 80%，因此表明具有成本效益。
尽管存在一些注意事项（排除基因-基因和基因-环境相互作用；简单的 5-HTTLPR 结构），但该模拟结果有利于将药物遗传学检测纳入抗抑郁治疗。
