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Gene panel to guide antiseizure medication prescribing: Does the cost justify the benefits?

Pharmacogenomics hold the potential to identify variants associated with adverse drug reactions and treatment efficacy of anti‐seizure medications. A model‐based cost‐utility analysis by Gordon and colleagues showed that genetically‐guided therapy costs more, yielded higher quality‐adjusted life years outcomes, and was considered to be cost‐effective compared to usual care. The study provided preliminary evidence on the value of pharmacogenetic testing in patients with drug‐resistant epilepsy. However, data input for the model was based on assumptions that need to be empirically tested. Further, there are many other factors that may affect the cost‐effectiveness of pharmacogenetic testing that need to be considered, including the model of service delivery, its implementation in complex clinical service, whether clinicians will modify treatment decisions based on pharmacogenetic information, and the fidelity with which recommendation on testing is adhered to in the real‐world. The cost‐effectiveness analysis should be repeated when more robust data on the effectiveness of pharmacogenetics are available and conducted alongside a budget impact analysis, incorporating the direct health care resources required to implement widespread testing and potential subsequent changes in treatment.