Pharmacogenetic testing for adverse drug reaction prevention: systematic review of economic evaluations and the appraisal of quality matters for clinical practice and implementation

Turongkaravee, S., Jittikoon, J., Rochanathimoke, O., Boyd, K. , Wu, O. and Chaikledkaew, U. (2021) Pharmacogenetic testing for adverse drug reaction prevention: systematic review of economic evaluations and the appraisal of quality matters for clinical practice and implementation. BMC Health Services Research, 21, 1042. (doi: 10.1186/s12913-021-07025-8) (PMID:34600523) (PMCID:PMC8487501)

Abstract

Background: Genetic testing has potential roles in identifying whether an individual would have risk of adverse drug reactions (ADRs) from a particular medicine. Robust cost-effectiveness results on genetic testing would be useful for clinical practice and policy decision-making on allocating resources effectively. This study aimed to update a systematic review on economic evaluations of pharmacogenetic testing to prevent ADRs and critically appraise the quality of reporting and sources of evidence for model input parameters. Methods: We searched studies through Medline via PubMed, Scopus and CRD’s NHS Economic Evaluation up to October 2019. Studies investigating polymorphism-based pharmacogenetic testing, which guided drug therapies to prevent ADRs, using economic evaluation methods were included. Two reviewers independently performed data extraction and assessed the quality of reporting using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines and the quality of data sources using the hierarchy of evidence developed by Cooper et al. Results: Fifty-nine economic evaluations of pharmacogenetic testing to avoid drug-induced ADRs were found between 2002 and 2018. Cost-utility and cost-effectiveness analyses were the most common methods of economic evaluation of pharmacogenetic testing. Most studies complied with the CHEERS checklist, except for single study-based economic evaluations which did not report uncertainty analysis (78%). There was a lack of high-quality evidence not only for estimating the clinical effectiveness of pharmacogenetic testing, but also baseline clinical data. About 14% of the studies obtained clinical effectiveness data of testing from a meta-analysis of case-control studies with direct comparison, which was not listed in the hierarchy of evidence used. Conclusions: Our review suggested that future single study-based economic evaluations of pharmacogenetic testing should report uncertainty analysis, as this could significantly affect the robustness of economic evaluation results. A specific ranking system for the quality of evidence is needed for the economic evaluation of pharmacogenetic testing of ADRs. Differences in parameters, methods and outcomes across studies, as well as population-level and system-level differences, may lead to the difficulty of comparing cost-effectiveness results across countries.

• Item Type: Articles
• Additional Information: Funding: This work is a part of a study in the Doctor of Philosophy program in Social, Economic and Administrative Pharmacy (SEAP), Faculty of Pharmacy, Mahidol University, Bangkok. Besides, this study was supported by grants from the International Research Network-the Thailand Research Fund (IRN60W003) and Health Systems Research Institute (HSRI61–080), Thailand.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wu, Professor Olivia and Boyd, Professor Kathleen
• Authors: Turongkaravee, S., Jittikoon, J., Rochanathimoke, O., Boyd, K., Wu, O., and Chaikledkaew, U.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: BMC Health Services Research
• Publisher: BioMed Central
• ISSN: 1472-6963
• Published Online: 02 October 2021
• Copyright Holders: Copyright © The Author(s) 2021
• First Published: First published in BMC Health Services Research 21: 1042
• Publisher Policy: Reproduced under a Creative Commons licence