Cost-Effectiveness Analysis of Pharmacogenetic Testing to Guide Treatment for Children With Asthma
Author(s)
Mingxuan Wu, MSc1, Katherine Payne, MSc, PhD1, Somnath Mukhopadhyay, MBBS, MD, PhD, FRCPCH, DCH2, Tom Ruffles, MBBS MRCPCH BSc2, Amy Haeffner, MSc3, Richard McManus, PhD FRCGP FRCP2, William Newman, PhD FRCP MA BSc4, Sean P. Gavan, BA, MSc, PhD1.
1Manchester Centre for Health Economics, The University of Manchester, Manchester, United Kingdom, 2Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom, 3Academic Department of Paediatrics, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom, 4Manchester Centre for Genomic Medicine, The University of Manchester, Manchester, United Kingdom.
1Manchester Centre for Health Economics, The University of Manchester, Manchester, United Kingdom, 2Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom, 3Academic Department of Paediatrics, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom, 4Manchester Centre for Genomic Medicine, The University of Manchester, Manchester, United Kingdom.
OBJECTIVES: Children with copies of the Arg16 allele for the ADRB2 gene encoding the β2-adrenergic receptor have an increased risk of asthma exacerbations with long-acting β2agonist (LABA) use. Emerging clinical evidence shows that pharmacogenetic testing in this population can reduce the likelihood of exacerbations. The aim of this study was to estimate the cost-effectiveness of ADRB2 pharmacogenetic testing to guide step controller therapy compared with usual care for children with asthma.
METHODS: A model-based cost-effectiveness analysis (decision tree and Markov model) simulated the difference in cost and quality-adjusted life years (QALYs) for children aged six (perspective: healthcare system, England). Intervention: all received pharmacogenetic testing to guide step therapy; leukotriene receptor antagonist (LTRA) if Arg16Arg, LABA otherwise. Usual care: all children received LABA. The simulation estimated the frequency of exacerbations until age eleven, primary and secondary healthcare, and quality of-life reductions. The difference in cost (£, 2024) and QALYs (EQ-5D-3L, UK tariff) were scaled using the ten-year incidence of children requiring second-line controller therapy. One-way and probabilistic sensitivity analyses explored uncertainty in all input parameters. Scenario analyses investigated how the cost-effectiveness of testing was affected by uptake, the relative effectiveness of LTRA, and across ethnicity subgroups.
RESULTS: Pharmacogenetic testing was cost-effective and dominant compared with usual care: per child, healthcare costs were £469.13 lower and QALYs were 0.0002 units higher. The results were robust to all sensitivity analyses and scenario analyses. At the population level over ten years, pharmacogenetic testing would avert around 55,000 asthma exacerbations, save healthcare systems around £35 million, and improve population health outcomes by 18.59 QALYs.
CONCLUSIONS: ADRB2 pharmacogenetic testing in primary care simultaneously improves health outcomes and reduces healthcare cost. Decision-makers can use this evidence to support the wider adoption of pharmacogenetic testing for children with asthma to improve patient outcomes and value to healthcare systems.
METHODS: A model-based cost-effectiveness analysis (decision tree and Markov model) simulated the difference in cost and quality-adjusted life years (QALYs) for children aged six (perspective: healthcare system, England). Intervention: all received pharmacogenetic testing to guide step therapy; leukotriene receptor antagonist (LTRA) if Arg16Arg, LABA otherwise. Usual care: all children received LABA. The simulation estimated the frequency of exacerbations until age eleven, primary and secondary healthcare, and quality of-life reductions. The difference in cost (£, 2024) and QALYs (EQ-5D-3L, UK tariff) were scaled using the ten-year incidence of children requiring second-line controller therapy. One-way and probabilistic sensitivity analyses explored uncertainty in all input parameters. Scenario analyses investigated how the cost-effectiveness of testing was affected by uptake, the relative effectiveness of LTRA, and across ethnicity subgroups.
RESULTS: Pharmacogenetic testing was cost-effective and dominant compared with usual care: per child, healthcare costs were £469.13 lower and QALYs were 0.0002 units higher. The results were robust to all sensitivity analyses and scenario analyses. At the population level over ten years, pharmacogenetic testing would avert around 55,000 asthma exacerbations, save healthcare systems around £35 million, and improve population health outcomes by 18.59 QALYs.
CONCLUSIONS: ADRB2 pharmacogenetic testing in primary care simultaneously improves health outcomes and reduces healthcare cost. Decision-makers can use this evidence to support the wider adoption of pharmacogenetic testing for children with asthma to improve patient outcomes and value to healthcare systems.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE216
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Pediatrics, Personalized & Precision Medicine, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)