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RISS 인기검색어
- 검색키워드
- 저자 : Chhibber, Anindit (검색결과 1 건)
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Drug Therapy Problems in Cystic Fibrosis: Clinical and Economic Potential of Pharmacogenetics
Chhibber, Anindit The University of Utah ProQuest Dissertations & Th 2023 해외박사(DDOD)
Combination therapies for cystic fibrosis (CF) have shown promise for improving survival but pose challenges in optimizing complex regimens for people with CF (PwCF). With advancements in CF drug development, PwCF now take a median of seven medications daily, increasing treatment complexity, risk of drug therapy problems (DTPs), and interference with treatment goals. Given the fact that most of these DTPs can be prevented with a preemptive pharmacogenetic testing, the overall goal of this study was to test the clinical and economic utility of a multi-gene pharmacogenetics (PGx) panel in reducing DTPs in PwCF. Firstly, an umbrella review identified 508 associations across 11 different meta-analysis studies and demonstrated that PwCF are being prescribed medications that are affected by individual genetic differences. Specifically, single nucleotide polymorphisms (SNPs) closer to genes such as ITGA9, NRXN3, KCNK1, KCNJ2, MC5R, PKD2L1, NWD1, MGST1 and IL16 genes were found to be associated with variable efficacy related and adverse event related outcomes. Secondly, an observational study was conducted at the University of Utah Health Care System to assess the clinical utility of a CYP450 PGx panel in PwCF. Results revealed that PGx intervention can enable approximately 4.2 treatment modifications per 10 patients in this patient population, which can alleviate the clinical burden of DTPs in PwCF and aid in determining pharmacotherapy recommendations. Lastly, a cost effectiveness study was conducted to assess the economic utility of the PGx panel in reducing DTPs in PwCF. Under the base-case, PwCF who received 'standard care' generated 16.36 quality associated life years (QALYs) and incurred $178,230 in costs during horizon period. Treatment guided with PGx testing resulted in 17.04 QALYs and costs of $149,070 resulting in health gains of 0.67 QALYs and a cost difference of $29,154 leading to a dominant incremental cost effectiveness ratio (ICER) implicating that standard-care has been strictly dominated by PGx-assisted care. This dissertation work provided a justification for achieving better clinical and economic outcomes in PwCF driven by currently available diagnostic and monitoring technology. Future research should evaluate which PwCF subgroups would most benefit from pharmacogenetic testing.
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