Health Economics and QOL Flashcards
Pt perspective
Predicting disease risk= negative impact on QOL
Guiding therapy= positive impact on QOL
Provider perspective
Predicting disease risk= not well used b/c they don’t know how to counsel on it
Guiding therapy= really well used and accepted
Industry perspective
Pharmaceutical industry= Mixed incentives= can be positive (genetic info can be useful and powerful and make the drug development process much more efficient) or negative (potentially if they fully implement PGx in drug development process they are going to decrease the market share [since it now only affects like 20-30% of population])
Diagnosis= mostly positive (since they can increase their market share since they can use it on more people)
Insurer perspective
Predicting disease risk= opens up a whole new realm for them to have to pay for more
Guiding therapy= opportunity for insurer to SAVE money since they don’t have to pay for as many complications from adverse events or from pt not responding to therapy
Government perspective
Concerned about safety and efficacy of drugs so they like PGx personalized medicine
Also deal with reimbursement b/c they control Medicare/Medicaid reimbursement and private insurers usually follow Mcare/Mcaid
Societal perspective
Looking at society at large rather than individual pts
Maximize benefits for all stakeholders
Minimize costs and risks
What are the factors to consider when deciding cost effectiveness?
5 factors that favor cost effectiveness
- Severe outcome
- Difficult drug monitoring that uses a lot of resources
- Strong genotype-phenotype association
- Rapid and relatively inexpensive assay
- More common mutation in population (polymorphism)
Incremental Cost Effectiveness Ration (ICER)
ratio of change of cost per change in effect of an intervention
usually expressed in QALY
Clinical validity
How true something is; how consistently and accurately the test can predict outcome
Clinical utility
how likely the test is to improve pt outcomes
Just b/c its valid does not mean its useful
6-Mercaptopurine metabolism
metabolized by TMPT to inactive form
So low levels of TPMT means higher levels of toxicity
mutations cause poor metabolizers
Toxicity and 6-MP
concerned with myelosuppression/ neutropenia with this chemo
100% of the PM required a dose reduction b/c they could not handle the full dose while about 30% of the heterozygous pts needed a dose reduction
If you decrease the dose of treatment can affect outcomes
Cost effectiveness and 6-MP
Homozygous gene frequency of 1%= cost effectiveness is clearly there
Gene frequency of 0.5% or less= cost of genetic test becomes important and cost effectiveness is retained if the cost of the genetic test is <$100
Dosing algorithms for warfarin
• Don’t have a really good way to dose warfarin in pts
○ Need to keep checking INR and adjusting before reaching ideal INR range
• Warfarin= Very narrow window therapeutic index drug
Even when you find the right dose, other things (foods, environment, etc) can interact with the drug and they are only in therapeutic range about 2/3 of the time (up to 20-fold variability in dose requirements)
CYP2C9 polymorphism
2C9 metabolizes warfarin so polymorphism will impair the enzyme and may cause over-anti-coagulation
PGx makes pts reach therapeutic INR quicker with fewer bleeding events
