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Drug Therapy Problems in Cystic Fibrosis: Clinical and Economic Potential of Pharmacogenetics- [electronic resource]
Drug Therapy Problems in Cystic Fibrosis: Clinical and Economic Potential of Pharmacogenetics- [electronic resource]
상세정보
- 자료유형
- 학위논문파일 국외
- 최종처리일시
- 20240214100124
- ISBN
- 9798380130431
- DDC
- 615
- 서명/저자
- Drug Therapy Problems in Cystic Fibrosis: Clinical and Economic Potential of Pharmacogenetics - [electronic resource]
- 발행사항
- [S.l.]: : The University of Utah., 2023
- 발행사항
- Ann Arbor : : ProQuest Dissertations & Theses,, 2023
- 형태사항
- 1 online resource(151 p.)
- 주기사항
- Source: Dissertations Abstracts International, Volume: 85-02, Section: B.
- 주기사항
- Advisor: Brixner, Diana I.
- 학위논문주기
- Thesis (Ph.D.)--The University of Utah, 2023.
- 사용제한주기
- This item must not be sold to any third party vendors.
- 초록/해제
- 요약Combination 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.
- 일반주제명
- Pharmaceutical sciences.
- 일반주제명
- Pharmacology.
- 일반주제명
- Health sciences.
- 키워드
- Cystic fibrosis
- 키워드
- Pharmacogenetics
- 기타저자
- The University of Utah Pharmacotherapy
- 기본자료저록
- Dissertations Abstracts International. 85-02B.
- 기본자료저록
- Dissertation Abstract International
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■00520240214100124
■006m o d
■007cr#unu||||||||
■020 ▼a9798380130431
■035 ▼a(MiAaPQ)AAI30424952
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a615
■1001 ▼aChhibber, Anindit.
■24510▼aDrug Therapy Problems in Cystic Fibrosis: Clinical and Economic Potential of Pharmacogenetics▼h[electronic resource]
■260 ▼a[S.l.]:▼bThe University of Utah. ▼c2023
■260 1▼aAnn Arbor :▼bProQuest Dissertations & Theses, ▼c2023
■300 ▼a1 online resource(151 p.)
■500 ▼aSource: Dissertations Abstracts International, Volume: 85-02, Section: B.
■500 ▼aAdvisor: Brixner, Diana I.
■5021 ▼aThesis (Ph.D.)--The University of Utah, 2023.
■506 ▼aThis item must not be sold to any third party vendors.
■520 ▼aCombination 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.
■590 ▼aSchool code: 0240.
■650 4▼aPharmaceutical sciences.
■650 4▼aPharmacology.
■650 4▼aHealth sciences.
■653 ▼aCost effectiveness
■653 ▼aCystic fibrosis
■653 ▼aDrug therapy problems
■653 ▼aPharmacogenetics
■653 ▼aPrecision medicine
■690 ▼a0572
■690 ▼a0566
■690 ▼a0419
■71020▼aThe University of Utah▼bPharmacotherapy.
■7730 ▼tDissertations Abstracts International▼g85-02B.
■773 ▼tDissertation Abstract International
■790 ▼a0240
■791 ▼aPh.D.
■792 ▼a2023
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T16931833▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
■980 ▼a202402▼f2024
