CYP2D6 genotyping in the daily routine of a psychiatric hospital – pharmacoeconomic evaluation
Abstract
Today, pharmacogenetic tests are commonly used to improve the efficacy and safety of antipsychotic (AP) treatment. However, the economic aspects of their implementation in the psychiatry clinic routine are not well studied.
Aim.To evaluate the pharmacoeconomic benefits of CYP2D6 polymorphisms genotyping in psychiatric patients.
Materials and methods. CYP2D6 genetic polymorphisms (*3, *4, *5, *6, *1ХN) were tested in 298 psychiatric in-patients. The mean AP daily doses and the hospital stay duration differed between poor (PM), extensive (EM) and ulta-rapid (UM) metabolizers. Based on these data, a pharmacoeconomic decision-making model was created. The model calculates direct medical costs for the patient care with and without pharmacogenetics tests.
Results. Pharmacogenetics tests (CYP2D6 genotyping) performed prior to the antipsychotic therapy were shown to be a cost-effective strategy as it gives additional clinical and pharmacological information, optimize the duration of AP treatment, and results in a lower direct medical cost of in-patient care. The cost of genotyping is less than 1% of the total direct medical costs. This strategy remains cost-effective even if the genotyping costs more than 3893.8 RUB (199% of the current value) and also if the differences in the hospital stay durations between PM, EM and UM are not less than 5 days.
About the Authors
A. A. Kurylev
P. P. Kashchenko Psychiatric hospital №1
Pavlov First Sankt-Peterburg State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
10 Menkovskaya Str., Nikolskoe 190005, Gatchinsky District, Leningrad Region, Russia
6-8 L'va Tolstogo Str., Sankt-Peterburg 197022, Russia
MD, Assistant at the Chair of clinical pharmacology and evidence-based medicine, Pavlov First Saint Petersburg State Medical University
B. V. Andreev
P. P. Kashchenko Psychiatric hospital №1
Sankt-Peterburg State University
Russian Federation
Russian Federation
10 Menkovskaya Str., Nikolskoe 190005, Gatchinsky District, Leningrad Region, Russia
7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia
MD, Professor & Chair, Department of pharmacology of St. Petersburg State University; Clinical pharmacologist, P. P. Kashchenko Psychiatric Hospital №1; St. Petersburg, Russia
A. S. Kolbin
Pavlov First Sankt-Peterburg State Medical University, Health Ministry of Russian Federation
Sankt-Peterburg State University
Russian Federation
Russian Federation
6-8 L'va Tolstogo Str., Sankt-Peterburg 197022, Russia
7-9 Universitetskaya Emb., Sankt-Peterburg 199034, Russia
MD, Professor & Chair, Department of clinical pharmacology and evidence-based medicine, Pavlov First Saint Petersburg State Medical University; Professor at the Department of Pharmacology of St. Petersburg State University. Tel.: 8(812)338 66 85
O. V. Limankin
P. P. Kashchenko Psychiatric hospital №1
Russian Federation
Russian Federation
10 Menkovskaya Str., Nikolskoe 190005, Gatchinsky District, Leningrad Region, Russia
MD, Director of the P. P. Kashchenko Psychiatric Hospital №1, St.Petersburg, Russia
References
1. Kurylev A. A., Brodyanskii V. M., Andreev B. V., Kibitov A. O. Psikhicheskoe zdorov’e (in russian). 2017; 15 (5): 26-35.
2. Kirnichnaya K. A., Sosin D. N., Ivanov M. V., Mikhailov V. A., Ivashchenko D. V., Ershov E. E., Taraskina A. E., Nasyrova R. F., Krupitskii E. M. Zhurnal nevrologii i psikhiatrii im SS Korsakova (in russian). 2015; 115 (4-1): 113-125.
3. Fursa O. O., Kozlovskii V. L. Sotsial’naya i klinicheskaya psikhiatriya (in russian). 2013; 23 (4): 51-55.
4. Ivashchenko D. V., Kibitov A. O., Sychev D. A. Psikhicheskoe zdorov’e (in russian). 2017; 15 (2): 91-95.
5. Sychev D. A. Pharmacogenetic testing: clinical interpretation of the results. Recommendations for practitioners (in russian). 2011. URL: http://pharmsuite.ru/download/Pharm/PhG.pdf. Accessed: 24.02.2017.
6. Mustafina O. E., Tuktarova I. A., Karimov D. D., Somova R. Sh., Nasibullin T. R. Genetika (in russian). 2015; 51 (1): 109-119.
7. Mosolov S. N., Tsukarzi E. E., Alfimov P. V. Sovremennaya terapiya psikhicheskikh rasstroistv (in russian). 2014; 1: 27-36.
8. Hasan A. et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J. Biol. Psychiatry Off. J. World Fed. Soc. Biol. Psychiatry. 2013; 14 (1): 2-44.
9. Hasan A., Falkai P., Wobrock T., Lieberman J., Glenthøj B., Gattaz W. F. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry. 2015 Apr; 16 (3): 142-70.
10. Hasan A. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J. Biol. Psychiatry Off. J. World Fed. Soc. Biol. Psychiatry. 2012; 13 (5): 318-378.
11. Ivashchenko D. V. Sosin D. N., Kirnichnaya K. A., Ershov E. E., Taraskina A. E., Ivanov M. V., Sychev D. A., Nasyrova R. F., Neznanov N. G. Farmakogenetika i farmakogenomika (in russian). 2015; 1: 30-39.
12. Kurylev A. A., Kurylev A. A., Vilyum I. A., Andreev B. V., Kolbin A. S. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology (in russian). 2012; 5: (4): 15-18.
13. Kurylev A. A., Andreev B. V., Vilyum I. A. Klinicheskaya farmakologiya i terapiya (in russian). 2012; 21 (5): 63-66.
14. Kurylev A. A., Brodyanskii V. M., Andreev B. V., Kibitov A. O. Sovremennaya terapiya psikhicheskikh rasstroistv (in russian). 2017; 1: 14-21.
15. Weinstein M. C. et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices-Modeling Studies. Value Health J. Int. Soc. Pharmacoeconomics Outcomes Res. 2003; 6 (1): 9-17.
16. Evaluation of medical technology. Recommendations for 2013 Under the general editorship of Y. B. Belousov [Otsenka meditsinskikh tekhnologii, Rekomendatsii 2013 g. Pod obshchei redaktsiei Yu.B. Belousova (in russian)]. Moscow. 2013; 40 s.
17. Ministry of Health of the Russian Federation. Order No. 163 dated May 27, 2011. On the approval of the industry standard “Clinical and Economic Research. General provisions» [Ministerstvo Zdravookhraneniya Rossiiskoi Federatsii. Prikaz №163 ot 27.05.2011. Ob utverzhdenii otraslevogo standarta «Kliniko-ekonomicheskie issledovaniya. Obshchie polozheniya» (in russian)].
18. Psychiatric care for patients with schizophrenia. Clinical manual (second edition). Edited by V. N. Krasnov, I. Ya. Gurovich, S. N. Mosolova, A. B. Shmukler [Psikhiatricheskaya pomoshch’ bol’nym shizofreniei. Klinicheskoe rukovodstvo (vtoroe izdanie). Pod redaktsiei V. N. Krasnova, I. Ya. Gurovicha, S. N. Mosolova, A. B. Shmuklera (in russian)]. Moscow. 2007; 260 s.
19. State register of maximum selling prices for medicinal products (in russian). URL: http://grls.rosminzdrav.ru/default.aspx. Accessed: 24.02.2017.
20. Data of the Department of Economics and Finance of St. Petersburg State Medical University “Psychiatric Hospital № 1 named after. P. P. Kashchenko» [Dannye otdela ekonomiki i finansov SPb GBUZ «Psikhiatricheskaya bol’nitsa №1 im. P. P. Kashchenko» (in russian)]. 2017.
21. Pricelist for molecular genetic studies of St. Petersburg City State Hospital “City Hospital No. 31” (in russian). URL: http://spbsverdlovka.ru/otdeleniya/diagnostika/laboratoriya-molekuliarnoygenetiki/135-prejskurant-na-molekulyarno-geneticheskieissledovaniya.html. Accessed: 15.11.2017.
22. Mosolov S. N., Tsukarzi E. E., Kapilettti S. G. Antipsychotic pharmacotherapy of schizophrenia: from scientific data to clinical recommendations. In: Biological methods of therapy of mental disorders (evidence-based medicine – clinical practice). Ed. S. N. Mosolov [Antipsikhoticheskaya farmakoterapiya shizofrenii: ot nauchnykh dannykh k klinicheskim rekomendatsiyam. V kn.: Biologicheskie metody terapii psikhicheskikh rasstroistv (dokazatel’naya meditsina – klinicheskoi praktike). Pod red. S. N. Mosolova (in russian)]. Moscow. 2012; 1080 c.
23. Kazakovtsev B. A., Demcheva N. K., Tvorogova N. A. Psychiatric assistance to the population of the Russian Federation in 2013: an analytical review [Psikhiatricheskaya pomoshch’ naseleniyu Rossiiskoi Federatsii v 2013 godu: analiticheskii obzor (in russian)]. Moscow. 2015; 223 s.
24. Perlis R. H. et al. Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model. J. Clin. Psychopharmacol. 2005; 25 (5): 427-434.
25. Rodríguez-Antona C. et al. CYP2D6 genotyping for psychiatric patients treated with risperidone: considerations for cost-effectiveness studies. Pharmacogenomics. 2009; 10 (4): 685-699.
26. Fleeman N. et al. The clinical effectiveness and cost-effectiveness of testing for cytochrome P450 polymorphisms in patients with schizophrenia treated with antipsychotics: a systematic review and economic evaluation. Health Technol. Assess. Winch. Engl. 2010; 14 (3): 1-157iii.
For citation:
Kurylev A.A., Andreev B.V., Kolbin A.S., Limankin O.V. CYP2D6 genotyping in the daily routine of a psychiatric hospital – pharmacoeconomic evaluation. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2018;11(1):19-26. (In Russ.) https://doi.org/10.17749/2070-4909.2018.11.1.019-026
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