Cost-Consequence Analysis of Using Neurofarmagen In The Decision-Making Process During The Treatment of Patients With Depression In The U.S

• Published in: Value in health 2017-10, Vol.20 (9), p.A713
• Main Authors: Espadaler, J, Carcedo, D, Pérez-Mitru, A, Menchón, J, Saiz-Ruiz, J, Bobes, J, Vieta, E, Alvarez, E, Pérez, V
• Format: Article
• Language: English
• Subjects: Chronic illnesses; Clinical trials; Counting; Decision making; First year; Health care expenditures; Help seeking behavior; Illnesses; Medical treatment; Mental depression; Patients; Relapse; Response rates; Robustness; Savings; Sensitivity analysis; Stabilization; Tau protein
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.1891

OBJECTIVES: Almost half of U.S. population has experienced at least one psychiatric disorder in their lifetime, being major depression (MD) the most common among these illnesses. MD is highly debilitating to society, due in part to the increased utilization of health care resources and their associated cost and to frequent suboptimal treatment responses. The aim of this study is to compare the cost and consequences of using the Neuropharmagen® (NFG) pharmacogenetic tool in the decision-making process of treating depression relapsed patients in the U.S. METHODS: A decision-tree model was developed in order to estimate the cost and consequences of using NFG over a 3-year time horizon. Model compared NFG testing-guided treatment vs. treatment as usual (TaU) in MD patients who had not responded to 1-3 previous treatment(s). Treatment response and stabilization rates were obtained from the 3-months assessment reported in the prospective randomized controlled trial of NFG and extrapolated up to 1 year. For "responder" patients, yearly relapse rate of 0.2 was considered. "Non-responder" and relapsed patients progressed to the next treatment line. The model considered direct costs (2017 US$) for "responder" and "non-responder" patients obtained from published literature RESULTS: In patients with 1-3 prior treatment failures, total management costs per patient (responder and non-responder) after 1 and 3 years were $1,307 and $4,172 lower in NFG testing-guided treatment compared with TaU respectively, not counting testing cost. 67.1% more patients achieved treatment response in NFG testing-guided treatment compared with TaU already first year (TaU response rate = 31.0%). Scenarios including other patient subgroups were tested, and one-way sensitivity analysis confirmed the robustness of these results CONCLUSIONS: In patients with 1 to 3 prior treatments, NFG testing-guided treatment of patients with MD will represent a cost-saving option vsTAU after 1 year. After 3-year time horizon, the analysis showed considerable savings