Page 163 - Genomic Medicine in Emerging Economies

152 CHAPTER 8: E c o n omic Evaluation and Cost-Effectiveness Analysis

also been investigated. For this, the HEALTH model (Health Economic Assess-
ment of Life with Teveten for Hypertension) was used (Schwander et al., 2009).
When a €30,000 willingness-to-pay threshold per QALY gained was consid-
ered, eprosartan was cost-effective in both primary (patients ≥50 years old
and a systolic blood pressure ≥160 mm Hg) and secondary prevention (all
investigated patients).

Antidepressants
Despite the case of coumarin derivates, the economic evaluation regarding
the use of pharmacogenetic tests to guide treatment in major depression
cases in high- and middle-income European countries showed that pharma-
cogenetic tests may be cost-effective in the high-income countries of Western
Europe, but not in the middle-income countries of Eastern Europe (Olgiati
et al., 2012). The study described the cost-utility of incorporating 5-HTTLPR
genotyping prior to drug treatment in the case of a major depressive disor-
der. The drugs citalopram or bupropion were selected, based on the response
and tolerability predicted by the 5-HTTLPR profile or standard treatment
guidelines. The model was constructed for the European regions with high
gross domestic product (GDP) (Austria, Belgium, Cyprus, the Czech Repub-
lic, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg,
Malta, the Netherlands, Portugal, Slovenia, Sweden, and the United King-
dom), middle GDP (Bulgaria, Poland, Romania, and Slovakia) and middle-
high GDP (Estonia, Hungary, Latvia, and Lithuania). The results showed that
in Eastern Europe a larger proportion of individuals were treated in inpa-
tient facilities, and hence the overall treatment cost was higher than that in
Western Europe, although the costs for the single service were lower. However,
the results also showed the same incremental cost for the pharmacogenetic
approach in all the European regions tested (ICER for regions with high GDP
was $1147; ICER for regions with middle GDP was $1158; ICER for regions
with middle-high GDP was $1179). The authors suggested that the critical
factor that determined whether the pharmacogenetic test was cost-effective
depended on the threshold, which was proportional to the economical level
of the county. The World Health Organization indicates an intervention as
highly cost-effective if ICER is inferior or equal to the GDP per capita, and
cost-effective if the ICER is between one and three times the GDP per cap-
ita (http://www.who.int/choice/costs/CER_thresholds/en). As data on costs
were from 2009, the current economic situation in the countries considered
might be significantly different now. The presented cost-utility model was
robust against the variations in all the parameters except for the cost of the
genetic test, which produced the greatest changes in ICER. It was suggested
that as long as genetic analysis is an expensive procedure, its applicability is
limited to the richest areas in the Eurozone.