Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

The Pharmacogenomics Journal (2008) 8, 391399 & 2008 Nature Publishing Group All rights reserved 1470-269X/08 $30.00

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ORIGINAL ARTICLE

Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

DF Heitjan1,2,3, DA Asch2,3,4,5,

Riju Ray3,6, Margaret

Rukstalis3,7, Freda Patterson3,7 and C Lerman2,3,4,7

1Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA;

2The Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA; 3Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA; 4The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 5The Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, Philadelphia, PA, USA;

6Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA and

7Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA

Correspondence:Professor DF Heitjan, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 622 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.

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Introduction

Pharmacogenetic research holds promise for the future tailoring of pharmacotherapy to improve treatment outcomes, including treatment for psychiatric conditions and addictive behaviors.1,2 For example, emerging data suggest that polymorphisms in central nervous system genes predict therapeutic response to antipsychotics,3 antidepressants,4 stimulant medications5 and pharmacotherapy for dependence on alcohol6 and tobacco.7 Genetic tests can also identify patients most likely to suffer adverse side effects of treatment, such as tardive dyskinesia8 and weight gain.9

As with any proposed treatment, evaluation of the cost-effectiveness of the pharmacogenetic approach should precede its translation to clinical practice.10,11

In this paper, we use data from several clinical trials of tobacco dependence treatment to inform an evaluation of the cost-effectiveness of a pharmacogenetic treatment strategy. Tobacco dependence treatment is a subject ripe for economic analysis, as smoking is the greatest single preventable cause of illness and death in the United States, adding an estimated $85 billion to the U.S. health care costs in 2001.1214 The topic is also of global significance, as the World Health Organisation estimates that there are currently 5 million tobacco-related deaths per year worldwide; the figure is expected to rise to 10 million by the early 2020s, with 70% in the developing world. Roughly half of long-term tobacco users die of tobacco-related diseases.15

Received 8 May 2007; revised 12 December 2007; accepted 20 December 2007;...