Does Pharmacogenetic Testing for CYP450 2D6 and 2C19 Among Patients with Diagnoses within the Schizophrenic Spectrum Reduce Treatment Costs?

The effect of pharmacogenetic testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without pharmacogenetic testi...

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Bibliographic Details
Published in:Basic & clinical pharmacology & toxicology 2013-10, Vol.113 (4), p.266-272
Main Authors: Herbild, Louise, Andersen, Stig E., Werge, Thomas, Rasmussen, Henrik B., Jürgens, Gesche
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Aged
Aryl Hydrocarbon Hydroxylases - genetics
Biological and medical sciences
CYP2D6 protein
Cytochrome P-450 CYP2C19
Cytochrome P-450 CYP2D6 - genetics
Denmark
Female
Genotype
Health Care Costs
Humans
Male
Medical sciences
Middle Aged
Models, Econometric
Pharmacogenetics - economics
Pharmacogenetics - methods
Pharmacology. Drug treatments
Polymorphism, Genetic
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychoses
Schizophrenia
Schizophrenia - economics
Schizophrenia - genetics
Schizophrenia - therapy
Young Adult
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Summary:The effect of pharmacogenetic testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate healthcare costs of treating patients with diagnoses within the schizophrenic spectrum for 1 year with or without pharmacogenetic testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treatment based on pharmacogenetic testing and 103 patients to treatment as usual. Random exclusion of extensive and intermediate metabolizers was used to increase the frequency of extreme metabolizers (poor metabolizers and ultrarapid metabolizers for CYP2D6) to 20% in both groups. Cost differences were analysed at several levels including (i) overall healthcare expenditure, (ii) psychiatric hospital cost (iii) nonpsychiatric hospital cost, (iv) primary care spending and (v) pharmaceuticals. Statistically significant differences in costs of psychiatric care dependent on metabolizer status were found between intervention groups. Pharmacogenetic testing significantly reduced costs among the extreme metabolizers (poor metabolizers and ultrarapid metabolizers) to 28%. Use of primary care services and pharmaceuticals was also affected by the intervention.This study confirms earlier findings that extreme metabolizers (poor and ultrarapid metabolizers) incur higher costs than similar patients with a normal metabolizer genotype. However, this study shows that these excess costs can be reduced by pharmacogenetic testing. Pharmacogenetic testing for CYP2D6 and CYP2C19 could thus be considered as a means of curtailing high psychiatric treatment costs among extreme metabolizers.
ISSN:1742-7835
1742-7843
DOI:10.1111/bcpt.12093