Cost-effectiveness of genetic and clinical predictors for choosing combined psychotherapy and pharmacotherapy in major depression

: Predictors of treatment outcome in major depressive disorder (MDD) could contribute to evidence-based therapeutic choices. Combined pharmacotherapy and psychotherapy show increased efficacy but higher cost compared with antidepressant pharmacotherapy; baseline predictors resistance be used identify patients more likely benefit from combined treatment. We performed a proof-of-principle study the cost-effectiveness using previously identified pharmacogenetic clinical risk factors (PGx-CL-R) or alone (CL-R) guide prescription vs pharmacotherapy. The these two strategies was standard care (ST, all subjects) three-year Markov model. Model parameters were literature-based estimates response treatment, costs (UK National Health System) benefits (quality-adjusted life years [QALYs], one QALY=one year lived perfect health). CL-R cost-effective than PGx-CL-R: one-QALY improvement £2341 for £3937 PGx-CL-R ST. had similar better when 1) genotyping £100 per subject less 2) test sensitivity ? 0.90 specificity 0.85. £3664 £4110 independent samples. lack validation large samples general population. Using predict strategy.