Wang Jiaqi, Pasternak Amy L, Maggo Simran, Mindanao Rochelle, Nguyen Jenny Q, Gong Cynthia L
Department of Pharmacy, Alfred E. Mann School of Pharmacy, University of Southern California, Los Angeles, California.
Department of Clinical Pharmacy, University of Michigan, College of Pharmacy, Ann Arbor, Michigan.
Pharmacogenet Genomics. 2025 Feb 1;35(2):81-86. doi: 10.1097/FPC.0000000000000549. Epub 2024 Oct 29.
Pharmacogenomic testing can optimize drug efficacy and minimize adverse effects. CYP3A5 polymorphisms affect the metabolism of tacrolimus. We sought to estimate the budget impact of preemptive pharmacogenomic testing for CYP3A5 in pediatric heart transplantation patients from an institutional perspective.
A decision tree was constructed to estimate the budget impact of pediatric heart transplant patients (age ≤18 years) initiated on tacrolimus with and without CYP3A5 pharmacogenomic testing. The budget impact of preemptive pharmacogenomic testing versus no pharmacogenomic testing was calculated. One-way sensitivity analysis and alternative analyses were conducted to assess the robustness of results to changes in model parameters.
CYP3A5 genotype-guided dosing provided savings of up to $17 225 per patient compared to standard dosing. These savings decreased to $11 759 when using another institution's data for the standard-dosing group. The time to achieve therapeutic concentration in the poor metabolizer genotype-guided dosing group had the largest impact on cost savings while the cost of the pharmacogenetic test had the smallest impact on cost savings.
Implementing CYP3A5 testing could save $17 225 per pediatric heart transplant patient receiving tacrolimus. As pharmacogenomic testing becomes more widespread, institutions should track resource requirements and outcomes to determine the best implementation policies going forward.
药物基因组学检测可优化药物疗效并将不良反应降至最低。CYP3A5基因多态性会影响他克莫司的代谢。我们试图从机构角度评估对小儿心脏移植患者进行CYP3A5预发性药物基因组学检测的预算影响。
构建决策树以评估接受和未接受CYP3A5药物基因组学检测的小儿心脏移植患者（年龄≤18岁）开始使用他克莫司时的预算影响。计算了预发性药物基因组学检测与不进行药物基因组学检测的预算影响。进行了单向敏感性分析和替代分析，以评估结果对模型参数变化的稳健性。
与标准给药相比，CYP3A5基因型指导给药可为每位患者节省高达17225美元。当使用另一家机构的标准给药组数据时，这些节省降至11759美元。在代谢不良者基因型指导给药组中达到治疗浓度的时间对成本节省影响最大，而药物遗传学检测成本对成本节省影响最小。
实施CYP3A5检测可为每位接受他克莫司治疗的小儿心脏移植患者节省17225美元。随着药物基因组学检测越来越普遍，各机构应跟踪资源需求和结果，以确定未来最佳的实施政策。
