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基因型特异性三环抗抑郁剂在患有重度抑郁症的患者中的剂量:基于试验的经济评估
Sophie E Ter Hark1, Wietske Kievit2, Gerjon Hannink3
1Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
概括
针对三环抗抑郁药剂剂量的先发性药物遗传学测试显示,医疗保健成本节省,但社会成本增加,与边际质量调整后生命年差异相差. 需要更多的长期研究来证实成本效益.
科学领域:
- 药物基因组学和精准医学
- 临床药理学 临床药理学
- 卫生经济学 卫生经济学
背景情况:
- 三环抗抑郁药 (TCA) 是有效的,但具有狭窄的治疗窗口和剂量依赖的副作用.
- 遗传变异,特别是CYP2D6和CYP2C19酶,影响TCA代谢和患者的反应.
- 个性化剂量策略旨在优化疗效并最大限度地减少不良事件.
研究的目的:
- 评估预防性CYP2D6和CYP2C19基因型告知三环抗抑郁剂剂量的成本效益.
- 从社会和医疗保健的角度来看,将药物遗传学知情治疗 (PIT) 与通常治疗 (TAU) 进行比较.
主要方法:
- 一个基于试验的成本效益分析,使用来自多中心随机对照PITA研究 (n=111) 的数据.
- 经质量调整的寿命年 (QALY) 和成本在13周和26周时被测量,并以2022年关税为索引.
- 使用引导方法评估不确定性,以50,000欧元/QALY的支付意愿计算增量净货币收益 (iNMB).
主要成果:
- 在PIT和TAU之间在13周和26周观察到QALY的边际差异.
- 医疗保健前景显示PIT节省了成本 (148欧元在13周,521欧元在26周).
- 社会视角表明PIT的成本增加 (13周1300欧元,26周1704欧元),在大多数场景中 iNMB是负的.
结论:
- 针对TCA剂量的先发性基因定型产生了边际的QALY差异和混合的成本效益结果.
- 医疗保健成本的节约被社会成本的增加所抵消.
- 需要进一步的长期观察性研究来确定这种药物遗传学方法的成本效益.
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