Abstract

Background. This article is based on a health technology assessment report completed in 2022 (health effects and cost-effectiveness of genotype-guided treatment for depression in Estonia, TTH61), which provides an overview of the effectiveness and cost-effectiveness of genotype-guided antidepressant treatment for depression. Pharmacogenomic testing can help predict which antidepressants and dosages are most likely to result in a strong response to treatment or to have the lowest risk of adverse events based on an individual’s genotype.
Objectives. To estimate the cost-effectiveness and budget impact of genotype-guided treatment for depression in Estonia. Methods. A decision tree model was developed to simulate the cost effectiveness of genotype-guided treatment for depression. A 24-week time perspective was used to perform the cost-effectiveness analysis, as there was no efficacy data beyond this period. The cohort used consisted of people who had previously been diagnosed with moderate to severe depression and for whom antidepressant treatment was indicated for the first time. Probabilities
and quality of life estimates were based on published literature. The analysis used the perspective of the Estonian Health Insurance Fund (EHIF), which was taken into account in determining the costs for the analysis. Results were presented in terms of cost, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER). A 5-year budget impact analysis was carried out from the healthcare payer’s perspective.
Results. The cost-effectiveness analysis showed that the ICER was €30,700 per QALY gained. In sensitivity analysis, the results were most influenced by the price of the genetic test. Applying genotype-guided antidepressant treatment in the population with moderate to severe depression for whom antidepressant treatment was indicated for the first time, would cost an additional €5.4 million within five years for the EHIF compared to usual care.
Conclusions. The cost-effectiveness of genotype-guided antidepressant treatment is likely to increase in the future as many people need recurrent antidepressant treatment during their lifetime, and existing genetic testing results can be used in the future for the treatment of other diseases.