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Review of the Cost Effectiveness of Pharmacogenetic-Guided Treatment of Hypercholesterolaemia

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Abstract

Hypercholesterolaemia is a highly prevalent condition that has major health and cost implications for society. Pharmacotherapy is an important and effective treatment modality for hypercholesterolaemia, with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (‘statins’) the most commonly used class of drugs. Over the past decade, there has been intensive research to identify pharmacogenetic markers to guide treatment of hypercholesterolaemia. This study aimed to review the evidence of incremental cost, effect and cost effectiveness of pharmacogenetic-guided treatment of hypercholesterolaemia. Three cost-effectiveness analyses (CEAs) were identified that studied the value of screening for genotypes of angiotensin I converting enzyme (ACE), cholesteryl ester transfer protein (CETP), and kinesin family member 6 (KIF6) prior to initiating statin therapy. For all three CEAs, a major limitation identified was the reproducibility of the evidence supporting the clinical effect of screening for the pharmacogenetic marker. Associated issues included the uncertain value of pharmacogenetic markers over or in addition to existing approaches for monitoring lipid levels, and the lack of evidence to assess the effectiveness of alternative therapeutic options for individuals identified as poor responders to statin therapy. Finally, the economic context of the market for diagnostic tests (is it competitive or is there market power?) and the practicality of large-scale screening programmes to inform prescribing in a complex and varied market may limit the generalizability of the results of the specific CEAs to policy outcomes. The genotype of solute carrier organic anion transporter family member 1B1 (SLCO1B1) has recently been associated with increased risk of muscle toxicity with statin therapy and the review identified that exploration of cost effectiveness of this pharmacogenetic marker is likely warranted.

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Acknowledgments

This work was supported by the National Heart Foundation of Australia [G11A5902]. The authors gratefully acknowledge the assistance of Sunjay Pekarsky-Norman in the preparation of Fig. 3. Michael Sorich and Brita Pekarsky are members of the Economics Sub-Committee of the Australian Pharmaceutical Benefits Advisory Committee, but the views expressed in this article are solely those of the authors. Rebekah O’Shea was employed by Bayer Australia Ltd until November 2009. All authors contributed to the conception and planning of the manuscript, drafting and critical revision of the manuscript, and approval of the final submitted version of the manuscript. Michael Sorich acts as guarantor for the overall content of this article.

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  1. School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia

    Michael J. Sorich & Michael D. Wiese

  2. Baker IDI Heart & Diabetes Institute, Adelaide, SA, Australia

    Rebekah L. O’Shea & Brita Pekarsky

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  1. Michael J. Sorich
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Sorich, M.J., Wiese, M.D., O’Shea, R.L. et al. Review of the Cost Effectiveness of Pharmacogenetic-Guided Treatment of Hypercholesterolaemia. PharmacoEconomics 31, 377–391 (2013). https://doi.org/10.1007/s40273-013-0045-6

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