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Ho TT, Smith DM, Aquilante CL, Cicali EJ, El Rouby N, Hertz DL, Imanirad I, Patel JN, Scott SA, Swain SM, Tuteja S, Hicks JK, the Pharmacogenomics Global Research Network Publication Committee. A Guide for Implementing DPYD Genotyping for Systemic Fluoropyrimidines into Clinical Practice. Clin Pharmacol Ther 2025; 117:1194-1208. [PMID: 39887719 PMCID: PMC11993294 DOI: 10.1002/cpt.3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 12/17/2024] [Indexed: 02/01/2025]
Abstract
The safety of systemic fluoropyrimidines (e.g., 5-fluorouracil, capecitabine) is impacted by germline genetic variants in DPYD, which encodes the dihydropyrimidine dehydrogenase (DPD) enzyme that functions as the rate-limiting step in the catabolism of this drug class. Genetic testing to identify those with DPD deficiency can help mitigate the risk of severe and life-threatening fluoropyrimidine-induced toxicities. Globally, the integration of DPYD genetic testing into patient care has varied greatly, ranging from being required as the standard of care in some countries to limited clinical use in others. Thus, implementation strategies have evolved differently across health systems and countries. The primary objective of this tutorial is to provide practical considerations and best practice recommendations for the implementation of DPYD-guided systemic fluoropyrimidine dosing. We adapted the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to cover topics including the clinical evidence supporting DPYD genotyping to guide fluoropyrimidine therapy, regulatory guidance for DPYD genotyping, key stakeholder engagement, logistics for DPYD genotyping, development of point-of-care clinical decision support tools, and considerations for the creation of sustainable and scalable DPYD genotype-integrated workflows. This guide also describes approaches to counseling patients about DPYD testing and result disclosure, along with examples of patient and provider educational resources. Together, DPYD testing and clinical practice integration aim to promote safe prescribing of fluoropyrimidine therapy and decrease the risk of severe and life-threatening fluoropyrimidine toxicities.
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Affiliation(s)
- Teresa T. Ho
- Department of PathologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - D. Max Smith
- Department of OncologyGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
- MedStar HealthColumbiaMarylandUSA
| | - Christina L. Aquilante
- Department of Pharmaceutical SciencesUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesAuroraColoradoUSA
- Colorado Center for Personalized MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Emily J. Cicali
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Nihal El Rouby
- Department of Pharmacy Practice and Administrative Sciences, James L Winkle College of PharmacyUniversity of CincinnatiCincinnatiOhioUSA
- St Elizabeth Health CareEdgewoodKentuckyUSA
| | - Daniel L. Hertz
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA
| | - Iman Imanirad
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Jai N. Patel
- Division of Cancer Pharmacology & PharmacogenomicsAtrium Health Levine Cancer InstituteCharlotteNorth CarolinaUSA
- Atrium Health Wake Forest Baptist Comprehensive Cancer CenterWinston‐SalemNorth CarolinaUSA
| | - Stuart A. Scott
- Department of PathologyStanford UniversityStanfordCaliforniaUSA
| | - Sandra M. Swain
- MedStar HealthColumbiaMarylandUSA
- Georgetown Lombardi Comprehensive Cancer CenterWashingtonDistrict of ColumbiaUSA
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of MedicinePerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - J. Kevin Hicks
- Department of PathologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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Bourke M, McInerney-Leo A, Steinberg J, Boughtwood T, Milch V, Ross AL, Ambrosino E, Dalziel K, Franchini F, Huang L, Peters R, Gonzalez FS, Goranitis I. The Cost Effectiveness of Genomic Medicine in Cancer Control: A Systematic Literature Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2025; 23:359-393. [PMID: 40172779 PMCID: PMC12053027 DOI: 10.1007/s40258-025-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2025] [Indexed: 04/04/2025]
Abstract
BACKGROUND AND OBJECTIVE Genomic medicine offers an unprecedented opportunity to improve cancer outcomes through prevention, early detection and precision therapy. Health policy makers worldwide are developing strategies to embed genomic medicine in routine cancer care. Successful translation of genomic medicine, however, remains slow. This systematic review aims to identify and synthesise published evidence on the cost effectiveness of genomic medicine in cancer control. The insights could support efforts to accelerate access to cost-effective applications of human genomics. METHODS The study protocol was registered with PROSPERO (CRD42024480842), and the review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) Guidelines. The search was run in four databases: MEDLINE, Embase, CINAHL and EconLit. Full economic evaluations of genomic technologies at any stage of cancer care, and published after 2018 and in English, were included for data extraction. RESULTS The review identified 137 articles that met the inclusion criteria. Most economic evaluations focused on the prevention and early detection stage (n = 44; 32%), the treatment stage (n = 36; 26%), and managing relapsed, refractory or progressive disease (n = 51, 37%). Convergent cost-effectiveness evidence was identified for the prevention and early detection of breast and ovarian cancer, and for colorectal and endometrial cancers. For cancer treatment, the use of genomic testing for guiding therapy was highly likely to be cost effective for breast and blood cancers. Studies reported that genomic medicine was cost effective for advanced and metastatic non-small cell lung cancer. There was insufficient or mixed evidence regarding the cost effectiveness of genomic medicine in the management of other cancers. CONCLUSIONS This review mapped out the cost-effectiveness evidence of genomic medicine across the cancer care continuum. Gaps in the literature mean that potentially cost-effective uses of genomic medicine in cancer control, for example rare cancers or cancers of unknown primary, may be being overlooked. Evidence on the value of information and budget impact are critical, and advancements in methods to include distributional effects, system capacity and consumer preferences will be valuable. Expanding the current cost-effectiveness evidence base is essential to enable the sustainable and equitable translation of genomic medicine.
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Affiliation(s)
- Mackenzie Bourke
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vivienne Milch
- Cancer Australia, Sydney, NSW, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Anna Laura Ross
- Science Division, World Health Organization, Geneva, Switzerland
| | - Elena Ambrosino
- Science Division, World Health Organization, Geneva, Switzerland
| | - Kim Dalziel
- Child Health Economics Unit, School of Population and Global Health, Centre for Health Policy, University of Melbourne, MelbourneMelbourne, VIC, Australia
| | - Fanny Franchini
- Faculty of Medicine, Dentistry and Health Sciences, Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Li Huang
- Child Health Economics Unit, School of Population and Global Health, Centre for Health Policy, University of Melbourne, MelbourneMelbourne, VIC, Australia
| | - Riccarda Peters
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia
| | - Francisco Santos Gonzalez
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia
| | - Ilias Goranitis
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3053, Australia.
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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Patrinos GP, Karamperis K, Koufaki MI, Skokou M, Kordou Z, Sparaki E, Skaraki M, Mitropoulou C. Systematic analysis of the pharmacogenomics landscape towards clinical implementation of precision therapeutics in Greece. Hum Genomics 2025; 19:11. [PMID: 39920803 PMCID: PMC11806879 DOI: 10.1186/s40246-025-00720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 01/19/2025] [Indexed: 02/09/2025] Open
Abstract
Pharmacogenomics (PGx) aims to delineate a patient's genetic profile with differences in drug efficacy and/or toxicity, particularly focusing on genes encoding for drug-metabolizing enzymes and transporters. Clinical implementation of PGx is a complex undertaking involving a multidisciplinary approach that includes, among others, a thorough understanding of a country's preparedness to adopt this modern discipline and a detailed knowledge of PGx biomarkers allelic spectrum at a population level. In several European populations, particularly in countries with lower income, clinical implementation of PGx is still in its infancy. We have previously performed a pilot study to determine the prevalence of PGx biomarkers in 18 European populations, as the first step towards population PGx at the European level. Here, we provide a comprehensive analysis of the current state of PGx in Greece, including a detailed allelic frequency spectrum of clinically actionable PGx biomarkers, the level of PGx education in academia, the provision of PGx testing services from public and private laboratories, and the aspects of the regulatory PGx environment, especially with respect to the discrepancies between the Greek National Organization of Medicines and the European Medicine Agency and health technology assessment. This study would not only provide the foundations for expediting the adoption of PGx in clinical reality in Greece but can also serve as a paradigm for replicating future studies in other European countries, to expand on previously available pilot studies.
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Affiliation(s)
- George P Patrinos
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece.
- College of Medicine and Health Sciences, Department of Genetics and Genomics, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates.
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates.
- Faculty of Medicine and Health Sciences, Department of Pathology, Clinical Bioinformatics Unit, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kariofyllis Karamperis
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
- The Golden Helix Foundation, London, UK
| | - Margarita-Ioanna Koufaki
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
| | - Maria Skokou
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
| | - Zoe Kordou
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
| | - Eirini Sparaki
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
| | - Margarita Skaraki
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras School of Health Sciences, University Campus, Rion, Patras, GR-265 04, Greece
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Moschella A, Mourou S, Perfler S, Zoroddu E, Bezzini D, Soru D, Trignano C, Miozzo M, Squassina A, Cecchin E, Floris M. Pharmacogenetic Information on Drug Labels of the Italian Agency of Medicines (AIFA): Actionability and Comparison Across Other Regulatory Agencies. Clin Transl Sci 2025; 18:e70138. [PMID: 39910906 PMCID: PMC11799589 DOI: 10.1111/cts.70138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/11/2024] [Accepted: 01/05/2025] [Indexed: 02/07/2025] Open
Abstract
To plan future steps for the implementation and regulation of pharmacogenetic testing, any issue in the management of pharmacogenetic information by regulatory bodies must be identified. In this paper, an analysis of pharmacogenetic information in the summary of product characteristics (SmCPs) of drugs approved by Italian Drug Agency (AIFA) was conducted. Among 4214 SmCPs of 1063 active ingredients, 53.2% (n = 2240) included pharmacogenetic information in at least one section, most frequently for drugs in the Anatomical Therapeutic Chemical category "Antineoplastic and immunomodulatory agents". To contextualize these data in the international scenario, a pharmacogenetic level of actionability, based on AIFA SmCPs, was assigned to 608 drug/gene pairs included in FDA's "Table of Pharmacogenomic Biomarkers in Drug Labels", according to PharmGKB (The Pharmacogenomics Knowledge Base). Approximately 67% of drug/gene pairs were deemed classifiable: Based on SmCPs phrasing, for half of them the genetic testing was cataloged as "required" or "recommended" (mainly tumor somatic variants), whereas 40% as "actionable" (mostly PK/PD-related germline variants). The comparison with other regulatory agencies highlighted a discordance in the assigned pharmacogenetic levels of actionability ranging from 1% to 14%. This discrepancy may also point out the need to rethink the language used in AIFA-approved SmCPs to clarify whether a pharmacogenetic test is necessary or not and for which subjects it has been recommended. For the first time, a detailed evaluation and comparative analysis of the pharmacogenetic information on Italian SmCPs was presented, placing it in an international context and laying the groundwork for rethinking pharmacogenetic indications in AIFA-approved SmCPs.
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Affiliation(s)
- Antonino Moschella
- Unit of Medical Genetics, Grande Ospedale Metropolitano Bianchi‐Melacrino‐MorelliReggio CalabriaItaly
| | - Soumaya Mourou
- Department of Biomedical SciencesUniversity of SassariSassariItaly
| | - Samantha Perfler
- Experimental and Clinical PharmacologyCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Enrico Zoroddu
- Department of Biomedical SciencesUniversity of SassariSassariItaly
| | - Daiana Bezzini
- Department of Life SciencesUniversity of SienaSienaItaly
| | | | - Claudia Trignano
- Department of Biomedical SciencesUniversity of SassariSassariItaly
| | - Monica Miozzo
- Medical Genetics Unit, Department of Health Sciences, ASST Santi Paolo e CarloUniversità Degli Studi di MilanoMilanItaly
| | - Alessio Squassina
- Department of Biomedical Sciences, Section of Neuroscience and Clinical PharmacologyUniversity of CagliariCagliariItaly
| | - Erika Cecchin
- Experimental and Clinical PharmacologyCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Matteo Floris
- Department of Biomedical SciencesUniversity of SassariSassariItaly
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Díaz-Villamarín X, Martínez-Pérez M, Nieto-Sánchez MT, Ruiz-Tueros G, Fernández-Varón E, Torres-García A, González Astorga B, Blancas I, Iáñez AJ, Cabeza-Barrera J, Morón R. Novel Genetic Variants Explaining Severe Adverse Drug Events after Clinical Implementation of DPYD Genotype-Guided Therapy with Fluoropyrimidines: An Observational Study. Pharmaceutics 2024; 16:956. [PMID: 39065653 PMCID: PMC11280107 DOI: 10.3390/pharmaceutics16070956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Fluoropyrimidines (FPs) are commonly prescribed in many cancer streams. The EMA and FDA-approved drug labels for FPs recommend genotyping the DPYD*2A (rs3918290), *13 (rs55886062), *HapB3 (rs56038477), alleles, and DPYD rs67376798 before treatment starts. We implemented the DPYD genotyping in our daily clinical routine, but we still found patients showing severe adverse drug events (ADEs) to FPs. We studied among these patients the DPYD rs1801265, rs17376848, rs1801159, rs1801160, rs1801158, and rs2297595 as explanatory candidates of the interindividual differences for FP-related toxicities, examining the association with the response to FPs . We also studied the impact of DPYD testing for FP dose tailoring in our clinical practice and characterized the DPYD gene in our population. We found a total acceptance among physicians of therapeutic recommendations translated from the DPYD test, and this dose tailoring does not affect the treatment efficacy. We also found that the DPYD*4 (defined by rs1801158) allele is associated with a higher risk of ADEs (severity grade ≥ 3) in both the univariate (O.R. = 5.66; 95% C.I. = 1.35-23.67; p = 0.014) and multivariate analyses (O.R. = 5.73; 95% C.I. = 1.41-28.77; p = 0.019) among FP-treated patients based on the DPYD genotype. This makes it a candidate variant for implementation in clinical practice.
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Affiliation(s)
- Xando Díaz-Villamarín
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
| | | | | | - Gabriela Ruiz-Tueros
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
| | - Emilio Fernández-Varón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18016 Granada, Spain
| | - Alicia Torres-García
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
| | - Beatriz González Astorga
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
- Medical Oncology, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Isabel Blancas
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
- Medical Oncology, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Antonio J. Iáñez
- Hospital Pharmacy, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - José Cabeza-Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
- Hospital Pharmacy, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Rocío Morón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), 18012 Granada, Spain
- Hospital Pharmacy, Hospital Universitario San Cecilio, 18016 Granada, Spain
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Wiss FM, Jakober D, Lampert ML, Allemann SS. Overcoming Barriers: Strategies for Implementing Pharmacist-Led Pharmacogenetic Services in Swiss Clinical Practice. Genes (Basel) 2024; 15:862. [PMID: 39062642 PMCID: PMC11276441 DOI: 10.3390/genes15070862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
There is growing evidence that pharmacogenetic analysis can improve drug therapy for individual patients. In Switzerland, pharmacists are legally authorized to initiate pharmacogenetic tests. However, pharmacogenetic tests are rarely conducted in Swiss pharmacies. Therefore, we aimed to identify implementation strategies that facilitate the integration of a pharmacist-led pharmacogenetic service into clinical practice. To achieve this, we conducted semi-structured interviews with pharmacists and physicians regarding the implementation process of a pharmacist-led pharmacogenetic service. We utilized the Consolidated Framework for Implementation Research (CFIR) to identify potential facilitators and barriers in the implementation process. Additionally, we employed Expert Recommendations for Implementing Change (ERIC) to identify strategies mentioned in the interviews and used the CFIR-ERIC matching tool to identify additional strategies. We obtained interview responses from nine pharmacists and nine physicians. From these responses, we identified 7 CFIR constructs as facilitators and 12 as barriers. Some of the most commonly mentioned barriers included unclear procedures, lack of cost coverage by health care insurance, insufficient pharmacogenetics knowledge, lack of interprofessional collaboration, communication with the patient, and inadequate e-health technologies. Additionally, we identified 23 implementation strategies mentioned by interviewees using ERIC and 45 potential strategies using the CFIR-ERIC matching tool. In summary, we found that significant barriers hinder the implementation process of this new service. We hope that by highlighting potential implementation strategies, we can advance the integration of a pharmacist-led pharmacogenetic service in Switzerland.
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Affiliation(s)
- Florine M. Wiss
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland; (D.J.); (M.L.L.)
- Institute of Hospital Pharmacy, Solothurner Spitäler, 4600 Olten, Switzerland
| | - Deborah Jakober
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland; (D.J.); (M.L.L.)
| | - Markus L. Lampert
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland; (D.J.); (M.L.L.)
- Institute of Hospital Pharmacy, Solothurner Spitäler, 4600 Olten, Switzerland
| | - Samuel S. Allemann
- Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland; (D.J.); (M.L.L.)
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7
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McDermott JH, Sharma V, Newman WG, Wilson P, Payne K, Wright S. Public preferences for pharmacogenetic testing in the NHS: Embedding a discrete choice experiment within service design to better meet user needs. Br J Clin Pharmacol 2024; 90:1699-1710. [PMID: 38616172 DOI: 10.1111/bcp.16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024] Open
Abstract
AIMS Genetic testing can be used to improve the safety and effectiveness of commonly prescribed medicines-a concept known as pharmacogenetics. This study aimed to quantify members of the UK public's preferences for a pharmacogenetic service to be delivered in primary care in the National Health Service. METHODS Members of the UK population were surveyed via an online panel company. Respondents completed 1 of 2 survey versions, asking respondents to select their preferred pharmacogenetic testing service in the context of a presentation of low mood or pain. A conditional logit model was estimated, before the best functional form for the dataset was identified. Preference heterogeneity was identified via latent class analysis. Coefficients from the final selected models were used to estimate uptake in the context of different hypothetical pharmacogenetic services. RESULTS Responses from 1993 individuals were included in the analysis. There were no differences observed in preference between the 2 clinical scenarios. Conditional logit analysis, using maximum likelihood estimation, indicated that respondents preferred to have noninvasive tests and wanted their data to be shared between different healthcare organizations to guide future prescribing. There was a preference for regional over national data sharing initiatives, and respondents preferred to have access to their data. Predicted uptake varied considerably, ranging from 51% to >99%, depending on design of the service. CONCLUSION This study identifies public preferences for a pharmacogenetic testing service and demonstrates how predicted uptake can be impacted by relatively minor adaptations. This highlights areas for prioritization during development of future pharmacogenetic services.
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Affiliation(s)
- John H McDermott
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Videha Sharma
- Division of Informatics, Centre for Health Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Stuart Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
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Fragoulakis V, Koufaki MI, Joefield-Roka C, Sunder-Plassmann G, Mitropoulou C. Cost-utility analysis of pharmacogenomics-guided tacrolimus treatment in Austrian kidney transplant recipients participating in the U-PGx PREPARE study. THE PHARMACOGENOMICS JOURNAL 2024; 24:10. [PMID: 38499549 DOI: 10.1038/s41397-024-00330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
Chronic kidney disease (CKD) is a global health issue. Kidney failure patients may undergo a kidney transplantation (KTX) and prescribed an immunosuppressant medication i.e., tacrolimus. Tacrolimus' efficacy and toxicity varies among patients. This study investigates the cost-utility of pharmacogenomics (PGx) guided tacrolimus treatment compared to the conventional approach in Austrian patients undergone KTX, participating in the PREPARE UPGx study. Treatment's effectiveness was determined by mean survival, and utility values were based on a Visual Analog Scale score. Incremental Cost-Effectiveness Ratio was also calculated. PGx-guided treatment arm was found to be cost-effective, resulting in reduced cost (3902 euros less), 6% less hospitalization days and lower risk of adverse drug events compared to the control arm. The PGx-guided arm showed a mean 0.900 QALYs (95% CI: 0.862-0.936) versus 0.851 QALYs (95% CI: 0.814-0.885) in the other arm. In conclusion, PGx-guided tacrolimus treatment represents a cost-saving option in the Austrian healthcare setting.
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Affiliation(s)
| | - Margarita-Ioanna Koufaki
- Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras, School of Health Sciences, Patras, Greece
| | - Candace Joefield-Roka
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Christina Mitropoulou
- The Golden Helix Foundation, London, UK.
- Department of Genetics and Genomics, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, Abu Dhabi, United Arab Emirates.
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9
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Fragoulakis V, Koufaki MI, Tzerefou K, Koufou K, Patrinos GP, Mitropoulou C. Assessing the utility of measurement methods applied in economic evaluations of pharmacogenomics applications. Pharmacogenomics 2024; 25:79-95. [PMID: 38288576 DOI: 10.2217/pgs-2023-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
An increasing number of economic evaluations are published annually investigating the economic effectiveness of pharmacogenomic (PGx) testing. This work was designed to provide a comprehensive summary of the available utility methods used in cost-effectiveness/cost-utility analysis studies of PGx interventions. A comprehensive review was conducted to identify economic analysis studies using a utility valuation method for PGx testing. A total of 82 studies met the inclusion criteria. A majority of studies were from the USA and used the EuroQol-5D questionnaire, as the utility valuation method. Cardiovascular disorders was the most studied therapeutic area while discrete-choice studies mainly focused on patients' willingness to undergo PGx testing. Future research in applying other methodologies in PGx economic evaluation studies would improve the current research environment and provide better results.
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Affiliation(s)
| | - Margarita-Ioanna Koufaki
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, 26504, Rio, Patras, Greece
| | - Korina Tzerefou
- University of Piraeus, Economics Department, 18534, Piraeus, Greece
| | | | - George P Patrinos
- University of Patras, School of Health Sciences, Department of Pharmacy, Laboratory of Pharmacogenomics & Individualized Therapy, 26504, Rio, Patras, Greece
- United Arab Emirates University, College of Medicine & Health Sciences, Department of Genetics & Genomics, P.O. Box. 15551, Al-Ain, Abu Dhabi, United Arab Emirates
- United Arab Emirates University, Zayed Center for Health Sciences, P.O. Box. 15551, Al-Ain, Abu Dhabi, United Arab Emirates
| | - Christina Mitropoulou
- The Golden Helix Foundation, London, SE1 8RT, UK
- United Arab Emirates University, Zayed Center for Health Sciences, P.O. Box. 15551, Al-Ain, Abu Dhabi, United Arab Emirates
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