Pharmacogenetics improves the efficacy and/or safety of drug therapy for a subset of the total patient population.

“The benefit of pharmacogenetic-informed prescribing is not distributed uniformly across a cohort but is derived from a minority of patients.”

Suthers GK and Polasek TM. Letter to the editor: reply to Bousman et al. Pharmacogenomics 2019 Oct;20(15):1061-1062.

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A ‘tipping point’ of evidence in support of pharmacogenetic-guided DSTs for antidepressant prescribing has been reached, particularly in the context of moderate to severe depression.

“Individuals receiving pharmacogenetic-guided DST therapy (n = 887) were 1.71 (95% CI: 1.17–2.48; p = 0.005) times more likely to achieve symptom remission relative to individuals who received treatment as usual (n = 850). Pharmacogenetic-guided DSTs might improve symptom remission among those with MDD.”

Bousman CA, et al. Pharmacogenetic tests and depressive symptom remission: a meta-analysis of randomized controlled trials. Pharmacogenomics 2019 Jan; 20(1):37-47.

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While many tests can fall into the category of pharmacogenomic testing for mental health, they generate different results. These tests cannot be lumped together as a class and should be reviewed independently.

“The level of disagreement in medication recommendations across the pharmacogenetic decision support tools (DSTs) indicates that these tests cannot be assumed to be equivalent or interchangeable.”

Bousman CA and Dunlop BW. Genotype, phenotype, and medication recommendation agreement among commercial pharmacogenomic-based decision support tools. The Pharmacogenomics Journal 2018; 18:613–22.

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Treatment-resistant depression (TRD) exacts substantial toll on quality of life and heavy price in treatment costs.

“Treatment-resistant depression exacts a heavy price in treatment costs and lost productivity, reaching into the tens of billions of dollars, but its effects on the lives of patients are just as devastating. In this literature review, the authors summarize 62 studies documenting the disease’s toll on quality of life, personal financial resources, and general health. The average patient in the included studies had experienced nearly four earlier episodes of depression, had not responded to 4.7 drug trials, and continued to meet or nearly meet criteria for severe depression.”

Mrazek DA, et al. A review of the clinical, economic, and societal burden of treatment-resistant depression: 1996-2013. Psychiatr Serv 2014 Aug 1; 65(8):977-87.

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TRD associated with higher per-patient medical costs.

“The classification of TRD had a clinically meaningful and statistically significant association with increased medical expenditures. Holding all else equal, the classification of TRD was associated with a 29.3% higher costs (P < 0.001) in medical expenditures compared with patients not meeting the study definition of TRD."

Olchanski N, et al. The economic burden of treatment-resistant depression. Clin Ther 2013; 35:512-22.

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Using atypical antipsychotics may improve clinical response in MDD patients who are refractory to antidepressant therapy.

“With antidepressant therapy alone, the estimated clinical response rate at 6 weeks was 30%.”

Taneja C, et al. Cost-effectiveness of adjunctive therapy with atypical antipsychotics for acute treatment of major depressive disorder. Ann Pharmacother 2012; 46:642-49.

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TRD imposes substantial cost on employers.

“Compared with major depressive disorder (MDD) controls, TRD-likely employees had significantly higher rates of mental-health disorders, chronic pain, fibromyalgia, and higher Charlson Comorbidity Index. Average direct 2-year costs were significantly higher for TRD-likely employees ($22,784) compared with MDD controls ($11,733), p < 0.0001. Average indirect costs were also higher among TRD-likely employees ($12,765) compared with MDD controls ($6885), p < 0.0001."

Ivanova JI, et al. Direct and indirect costs of employees with treatment-resistant and non-treatment resistant major depressive disorder. Curr Med Res Opin 2010 Oct; 26(10):2475-84.

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Individuals with TRD use more healthcare services.

“The average annual cost of employees considered TRD-likely was dollars US 14490 per employee, while the cost for depressed but TRD-unlikely employees was dollars US 6665 per employee, and dollars US 4043 for the employee from the random sample. TRD beneficiaries used more than twice as many medical services compared with TRD-unlikely patients, and incurred significantly greater work loss costs.”

Greenberg P, et al. Economic implications of treatment-resistant depression among employees. Pharmacoeconomics 2004; 22(6):363-73.

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