Economic Evaluation of a Point of Care Pharmacogenetic Test (CYP2C19) from an Ontario Perspective

Abstract Background: Appropriate pharmacotherapy for patients with acute coronary syndrome depends on the functional capacity of their CYP2C19*2 allele. Patients with a fully functional allele could be treated with clopidogrel while prasugrel or ticagrelor could be prescribed to patients with a loss of function allele. Pharmacogenetic (PGx) testing could optimize pharmacotherapy (i.e. fewer adverse event rates with PGx option, where results are available in 1 hour) Purpose: To quantify net social benefit of implementing a PGx test in Ontario hospitals. Methods: A systematic review identified the evidence from full economic evaluations related to the CYP2C19*2 PGx test. An exploratory review highlighted the structure of published discrete choice experiments (DCEs) related to pharmaceutical therapeutics. Components used to quantify net social benefit were: patient preference expressed as willingness to pay, budget impact (BIA) analysis (aggregate Ontario hospitals, and Ontario Drug Formulary) and impact on productivity. Principles and good practice guidance as presented by the International Society for Pharmacoeconomic and Outcome Research Task force were adhered to for the BIA. A web survey tool that included a DCE was developed to assess preferences for attributes (levels) of a PGx test (i.e. mode of sample collection (cheek swab, blood, or finger prick), and turnaround time for results (1 hour, 3 days and 1 week). Cost was added to quantify the WTP of each attribute. To ascertain starting point bias with respect to the cost attribute, respondents were presented with one of two sets of costs (Version 1: $0, $1, and $5 or Version 2: $0, $2 and $10). Conditional logit regression was used to analyze data. Results: Regression coefficients were statistically significant for turnaround times as well as for cost regardless of the sample on which they were calculated. WTP for 1 hour versus a 3 day turnaround time was $2.91 (Confidence intervals (CI $1.90, $4.07) in additional annual premiums. WTP values were higher for 1 hour versus 1 week turnaround times. The results suggest that a net social benefit of over $9 million. Conclusions: Respondents showed a preference for 1 hour turnaround time for test results but no statistically significant preference in how samples were extracted. Given the financial constraints, hospital administrator decision to fund the PGx test would need to balance the additional $3.5 million expenditure to cover the PGx option with the potential benefit of 981 fewer adverse events.

Department dc:contributor.department

Pharmaceutical Sciences

Year dc:date.issued

2017

Author dc:creator

• Bereza, Basil Gregory

Advisors dc:contributor.advisor

• Papadimitropoulos, Emanual
• Grootendorst, Paul

• Budget impact analysis
• Cost benefit analysis
• Discrete choice experiment
• Pharmacogenetics

Handle dc:identifier.uri

http://hdl.handle.net/1807/82395

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/82395