Pharmacogenomic Testing in Depression: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

This review was comprised of one health technology assessment report, two systematic reviews with meta-analyses, one randomized controlled trial, and three economic evaluations regarding pharmacogenomic testing versus treatment as usual for treating all severities of diagnosed depression.

One health technology assessment report suggested that the evidence for pharmacogenomic testing for depressive disorders was limited and of low to very low quality for different outcomes measured. The authors concluded that the evidence was insufficient for forming conclusions regarding clinical use. One systematic review with meta-analysis suggested that pharmacogenetic-guided prescribing had a positive effect on the likelihood of achieving symptom remission which may be confined to individuals with moderate to severe depression and a history of inadequate response or intolerability to previous psychotropic medications. One systematic review with meta-analysis suggested that the evidence was limited in quality and quantity and that primary studies suggestive of a positive effect of pharmacogenomic testing in major depressive disorders were mostly of low quality. One randomized controlled trial reported no significant difference in the improvement of depressive symptoms or safety outcomes between pharmacogenomic testing guided and unguided groups.

The health technology assessment report stated that results in one cost-effectiveness study suggested moderate cost-effectiveness of pharmacogenomics testing given the probability of having an incremental cost-effectiveness ratio below the international $1,926 cost-effectiveness threshold was 90%, while another study suggested that based on the commonly used threshold of $50,000 per quality-adjusted life year, pharmacogenomics testing would not be cost-effective. One included systematic review reported the probability of pharmacogenomics testing being cost-effective at the willingness to pay threshold of $50,000 was 94.5%. One9 of the three included economic evaluations reported the lack of conclusion on cost-effectiveness of screening for CYP2D6 in primary care patients using antidepressants. Two economic evaluations reported that pharmacogenomics testing was dominant over treatment as usual.

One guideline within the health technology assessment report recommended that a combination of therapeutic drug monitoring and genotyping may be informative in potentially nonadherent patients.