Estimating the Danish populations' preferences for pharmacogenetic testing using a discrete choice experiment. The case of treating depression.

OBJECTIVE The objective is to estimate willingness-to-pay (WTP) for pharmacogenetic testing in the treatment of depression. METHODS In a web-based discrete choice questionnaire, four attributes were included: 1) number of changes in antidepressants before symptom relief; 2) time with dosage adjustments due to adverse side effects and/or lack of effects; 3) cost of pharmacogenetic testing; 4) probability of benefits from pharmacogenetic testing. Respondents were asked to choose between two scenarios; 1) pharmacogenetic testing; and 2) an opt-out option reflecting a scenario without pharmacogenetic testing. The indirect utility model was assumed to be multiplicative in probability of benefits and reduced time with dosage adjustments as well as reduced number of antidepressant changes. RESULTS Most coefficients had the expected signs and were statistically significant. WTP for avoidance of one change in antidepressant medication is 1571 Danish Krone (DKK), whereas WTP for reducing the period with dosage-adjustments by 1 month is DKK604. Both were statistically significantly different from zero. CONCLUSION If diagnosed with depression, peoples' WTP for pharmacogenetic testing appears to exceed its price as long as there is a reasonable probability for improvements in treatment (in the present case 10%). Utility is associated with outcomes only. Hence, other modes of provision of similar improvements in treatment may be valued equally highly. WTP estimates and the associated policy implications appear to be robust because they were unaffected by estimation model.

[1]  S. Brophy,et al.  Interventions for latent autoimmune diabetes (LADA) in adults. , 2011, The Cochrane database of systematic reviews.

[2]  A. Hofman,et al.  Influence of the CYP2D6*4 polymorphism on dose, switching and discontinuation of antidepressants. , 2008, British journal of clinical pharmacology.

[3]  D. Gyrd-Hansen,et al.  Patient preferences for pharmacogenetic screening in depression , 2008, International Journal of Technology Assessment in Health Care.

[4]  Christoph Hiemke,et al.  Clinical utility of drug measurement and pharmacokinetics – therapeutic drug monitoring in psychiatry , 2008, European Journal of Clinical Pharmacology.

[5]  Arne Risa Hole,et al.  A comparison of approaches to estimating confidence intervals for willingness to pay measures. , 2007, Health economics.

[6]  P. Sobocki,et al.  The economic burden of depression in Sweden from 1997 to 2005 , 2007, European Psychiatry.

[7]  P. Cuijpers,et al.  Economic costs of minor depression: a population‐based study , 2007, Acta psychiatrica Scandinavica.

[8]  S. Riedel-Heller,et al.  Cost-of-illness studies of depression: a systematic review. , 2007, Journal of affective disorders.

[9]  David B Matchar,et al.  Testing for cytochrome P450 polymorphisms in adults with non-psychotic depression treated with selective serotonin reuptake inhibitors (SSRIs). , 2007, Evidence report/technology assessment.

[10]  Hilmar Luthe,et al.  AmpliChip CYP450 GeneChip®: A New Gene Chip That Allows Rapid and Accurate CYP2D6 Genotyping , 2006, Therapeutic drug monitoring.

[11]  B. Jönsson,et al.  The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression , 2006, International journal of clinical practice.

[12]  A. Egberts,et al.  The impact of Cytochrome P450‐2D6 genotype on the use and interpretation of therapeutic drug monitoring in long‐stay patients treated with antidepressant and antipsychotic drugs in daily psychiatric practice , 2006, Pharmacoepidemiology and drug safety.

[13]  K. A. Nielsen,et al.  CYP2D6 gene test in psychiatric patients and healthy volunteers , 2006, Scandinavian journal of clinical and laboratory investigation.

[14]  D. Goldstein,et al.  Drug‐metabolizing enzymes: Evidence for clinical utility of pharmacogenomic tests , 2005, Clinical pharmacology and therapeutics.

[15]  Magnus Ingelman-Sundberg,et al.  The human genome project and novel aspects of cytochrome P450 research. , 2005, Toxicology and applied pharmacology.

[16]  John M. Rose,et al.  Applied Choice Analysis: A Primer , 2005 .

[17]  Magnus Ingelman-Sundberg,et al.  Pharmacogenetics of drug-metabolizing enzymes: implications for a safer and more effective drug therapy , 2005, Philosophical Transactions of the Royal Society B: Biological Sciences.

[18]  A. Børglum,et al.  [Status of and perspectives on psychiatric genomic medicine]. , 2005, Ugeskrift for laeger.

[19]  John M. Rose,et al.  Applied Choice Analysis: List of tables , 2005 .

[20]  John M. Rose,et al.  Applied Choice Analysis: List of tables , 2005 .

[21]  M Ingelman-Sundberg,et al.  Genetic polymorphisms of cytochrome P450 2D6 (CYP2D6): clinical consequences, evolutionary aspects and functional diversity , 2005, The Pharmacogenomics Journal.

[22]  Y. Caraco Genes and the response to drugs. , 2004, The New England journal of medicine.

[23]  J. Ahlner,et al.  Fatal intoxication cases: cytochrome P 450 2D6 and 2C19 genotype distributions , 2004, European Journal of Clinical Pharmacology.

[24]  N. Thuerauf,et al.  CYP2D6 Genotype: Impact on Adverse Effects and Nonresponse During Treatment with Antidepressants—a Pilot Study , 2004, Clinical pharmacology and therapeutics.

[25]  J. Leon,et al.  Cytochrome P450 2D6 and Antidepressant Toxicity and Response: What is the Evidence? , 2004, Clinical pharmacology and therapeutics.

[26]  J Licinio,et al.  Pharmacogenetics of antidepressants and antipsychotics: the contribution of allelic variations to the phenotype of drug response , 2004, Molecular Psychiatry.

[27]  M. Ryan,et al.  Modelling non-demanders in choice experiments. , 2004, Health economics.

[28]  A. Rush,et al.  The cost consequences of treatment-resistant depression. , 2004, The Journal of clinical psychiatry.

[29]  K. Brøsen Some aspects of genetic polymorphism in the biotransformation of antidepressants. , 2004, Therapie.

[30]  A. Lloyd Threats to the estimation of benefit: are preference elicitation methods accurate? , 2003, Health economics.

[31]  E. Heerdink,et al.  Impact of coaching by community pharmacists on drug attitude of depressive primary care patients and acceptability to patients; a randomized controlled trial , 2003, European Neuropsychopharmacology.

[32]  L. Bertilsson,et al.  Increased incidence of CYP2D6 gene duplication in patients with persistent mood disorders: ultrarapid metabolism of antidepressants as a cause of nonresponse. A pilot study , 2003, European Journal of Clinical Pharmacology.

[33]  Ian J. Bateman,et al.  Economic Valuation With Stated Preference Techniques , 2002 .

[34]  J. Cairns,et al.  Decision making heuristics and the elicitation of preferences: being fast and frugal about the future. , 2002, Health economics.

[35]  H. Birnbaum,et al.  Identification of a Claims Data "Signature" and Economic Consequences for Treatment-Resistant Depression , 2002 .

[36]  I. Bateman Economic valuation with stated preference techniques : a manual : department for transport , 2002 .

[37]  S. Kasper,et al.  CYP2D6 and CYP2C19 genotype‐based dose recommendations for antidepressants:
a first step towards subpopulation‐specific dosages , 2001, Acta psychiatrica Scandinavica.

[38]  I. Anderson,et al.  Meta-analytical studies on new antidepressants. , 2001, British medical bulletin.

[39]  M Schwab,et al.  Elucidation of the genetic basis of the common 'intermediate metabolizer' phenotype for drug oxidation by CYP2D6. , 2000, Pharmacogenetics.

[40]  M. Cronin,et al.  Extension of a pilot study: impact from the cytochrome P450 2D6 polymorphism on outcome and costs associated with severe mental illness. , 2000, Journal of clinical psychopharmacology.

[41]  Fortunato Rizzo,et al.  Depression: cost-of-illness studies in the international literature, a review. , 2000, The journal of mental health policy and economics.

[42]  J. Ratcliffe THE USE OF CONJOINT ANALYSIS TO ELICIT WILLINGNESS-TO-PAY VALUES , 2000, International Journal of Technology Assessment in Health Care.

[43]  N. Pidgeon,et al.  On the Contingent Valuation of Safety and the Safety of Contingent Valuation: Part 1-Caveat Investigator , 1998 .

[44]  P. Keck,et al.  Standards of laboratory practice: antidepressant drug monitoring , 1998 .

[45]  M. Privitera,et al.  Standards of laboratory practice: antiepileptic drug monitoring , 1998 .

[46]  P. Keck,et al.  Standards of laboratory practice: antidepressant drug monitoring. National Academy of Clinical Biochemistry. , 1998, Clinical chemistry.

[47]  G. Loomes,et al.  Imprecise Preferences and Survey Design in Contingent Valuation , 1997 .

[48]  A H Briggs,et al.  Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. , 1997, Health economics.

[49]  R. Tibshirani,et al.  An Introduction to the Bootstrap , 1995 .

[50]  Richard T. Carson,et al.  The Issue of Scope in Contingent Valuation Studies , 1993 .

[51]  J. Louviere,et al.  The Role of the Scale Parameter in the Estimation and Comparison of Multinomial Logit Models , 1993 .

[52]  A. Nierenberg The medical consequences of the selection of an antidepressant. , 1992, The Journal of clinical psychiatry.

[53]  K. Brown,et al.  Are any numbers better than no numbers? The sorry state of willingness-to-pay and some major methodological shortcomings. , 1992, Australian health review : a publication of the Australian Hospital Association.

[54]  J. Mccombs,et al.  The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a Medicaid population. , 1990, The Journal of clinical psychiatry.

[55]  L. Balant,et al.  High blood concentrations of imipramine or clomipramine and therapeutic failure: a case report study using drug monitoring data. , 1989, Therapeutic drug monitoring.

[56]  N. Holtzman Proceed with caution , 1989 .

[57]  P. Slovic,et al.  Preference Reversals: A Broader Perspective , 1983 .

[58]  A. Tversky,et al.  The framing of decisions and the psychology of choice. , 1981, Science.

[59]  P. Slovic,et al.  Reversals of preference between bids and choices in gambling decisions. , 1971 .

[60]  Paul Slovic,et al.  Effect of instruction in expected value on optimality of gambling decisions , 1969 .

[61]  P. Slovic,et al.  Relative importance of probabilities and payoffs in risk taking , 1968 .