Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Abstract

Lorena Carrascal-Laso,1 Manuel Ángel Franco-Martín,1 Elena Marcos-Vadillo,2 Ignacio Ramos-Gallego,3 Belén García-Berrocal,2 Eduardo Mayor-Toranzo,1 Santiago Sánchez-Iglesias,4 Carolina Lorenzo,4 Alfonso Sevillano-Jiménez,1 Almudena Sánchez-Martín,5 María Jesús García-Salgado,2 María Isidoro-García2,6 1Servicio de Psiquiatría, Hospital Provincial de Zamora, IBSAL, Zamora, 49071, Spain; 2Farmacogenética y Medicina de Precisión, Servicio de Bioquímica, Hospital Universitario de Salamanca, IBSAL, Salamanca, 37007, Spain; 3Departamento de Fisiología y Farmacología, Universidad de Salamanca, Salamanca, 37007, Spain; 4Servicio de Psiquiatría, Hospital Universitario de Salamanca, IBSAL, Salamanca, 37007, Spain; 5Pharmacogenetics Unit, Pharmacy Department, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Granada, 18014, Spain; 6Departamento de Medicina, Universidad de Salamanca, Salamanca, 37007, SpainCorrespondence: Manuel Ángel Franco-Martín Email [email protected]: Schizophrenia is a severe mental disorder that often manifests within the first three decades of life. Its prognosis is uncertain and may result in a prolonged treatment that could extend throughout the entire lifespan of the patient. Antipsychotic drugs are characterized by a high interindividual variability when considering therapeutic effect and emergence of adverse effects. Such interindividual variability is thought to be associated primarily with pharmacokinetic matters.Objective: The objective of this study was to evaluate the economic impact of the application of the 5-Step Precision Medicine model (5SPM), an approach based on the pharmacogenetic analysis of the primary genes involved in the metabolism of the therapy for each patient, restructuring treatment as necessary.Patients and Methods: One hundred eighty-eight psychiatry patients were analysed for single nucleotide polymorphisms on genes CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5 and ABCB1. Information on patients’ diagnosis, pharmacotherapy, and hospitalizations was collected.Results: We achieved a cost–benefit ratio of 3.31– 3.59 with a reduction of direct cost (hospitalizations plus pharmacotherapy) with a reduction of total cost in 67% of the patients who underwent the clinical intervention.Conclusion: A rational Precision Medicine-based approach to psychiatric patients could result in a reduction on number of drugs required to control exacerbations, and the underlying pathologies, reducing the risk of adverse effects and improving adherence to treatment, leading to a potential decrease in direct costs. This methodology has been shown to be cost-dominant and, being based on a pharmacogenetic analysis, it has a lifelong nature, as the data obtained can be applied to other medical disciplines.Keywords: pharmacogenetics, pharmacoeconomics, psychotic disorders, cytochrome P-450, antipsychotics

Keywords

• pharmacogenetics
• pharmacoeconomics
• psychotic disorders
• cytochrome p-450
• antipsychotics