:Background:In a study conducted in the database of a large commercial healthcare insurer, we previously demonstrated that use of a commercial pharmacogenetic assay for individuals with mood disorders was associated with decreased resource utilization and cost in the 6 month period following use compared to propensity-score matched controls. We conducted a post hoc analysis to understand variables associated with high cost savings.Methods:The results and methods of the initial study have previously been described. Cases were individuals with mood and anxiety disorders who received a commercial pharmacogenetic assay (Genomind, King of Prussia PA) to inform pharmacotherapy. 817 tested individuals (cases) with mood and/or anxiety disorders were matched to 2745 controls. Overall costs were estimated to be $1,948 lower in the tested group. The differences were largely the result of lesser emergency room and inpatient utilization for cases. In the present analysis, cost difference for cases compared to their matched controls was rank ordered by decile. High cost savers were arbitrarily defined a priori as the top 20% of savers. Using multivariable modeling techniques, an ordinal logistic regression model was generated in which baseline or follow-up variables were statistically tested for independent associations with high, low, and no cost savings.Results:606 (74%) of cases were net cost savers compared to their controls (cost difference <0). High cost savers (n=121) saved on average $10,690 compared to their matched controls. They were statistically more likely to have been diagnosed with bipolar disorder (n=33/121) than low cost savers (n=57/485) or non-savers (n=31/211), and had a lower Charlson Comorbidity index. High cost savers had fewer mean number of antidepressants in the baseline period (mean=3.16) compared to non-savers (3.73) but more than low cost savers (2.72) (p<0.05 across groups). In a multivariable model, bipolar, count of antidepressants, outpatient visits, and inpatient visits were statistically associated with being a high cost saver; antidepressant count and all-cause inpatient and outpatient visits in the baseline period were inversely associated with cost savings.Conclusions:Use of a pharmacogenetic assay was associated with cost-savings in the database of a large commercial insurer. Patients with bipolar disorder were more likely to be high cost savers than individuals with other mood and anxiety disorders.Funding Acknowledgements:Genomind

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在情绪和焦虑症患者中使用药物遗传学分析后与成本节约相关的 128 个因素

背景：在一家大型商业医疗保险公司的数据库中进行的一项研究中，我们之前证明，与倾向相比，对情绪障碍患者使用商业药物遗传学检测与使用后 6 个月内资源利用率和成本降低有关- 得分匹配的控件。我们进行了事后分析，以了解与高成本节约相关的变量。方法：初步研究的结果和方法之前已经描述过。病例是患有情绪和焦虑症的个体，他们接受了商业药物遗传学检测（Genomind，普鲁士国王 PA）以告知药物治疗。817 名情绪和/或焦虑症受试个体（病例）与 2745 名对照组相匹配。测试组的总成本估计要低 1,948 美元。差异主要是由于急诊室和住院病人的病例使用较少。在本分析中，病例与其匹配对照相比的成本差异按十分位排序。高成本储蓄者被任意定义为前 20% 的储蓄者。使用多变量建模技术，生成了一个序数逻辑回归模型，其中基线或后续变量进行了统计测试，以了解与高、低和无成本节约的独立关联。结果：606 (74%) 的案例是净成本节约者比较到他们的控制（成本差异<0）。与匹配的对照组相比，高成本储蓄者 (n=121) 平均节省了 10,690 美元。与低成本储蓄者 (n=57/485) 或非储蓄者 (n=31/211) 相比，他们在统计学上更有可能被诊断出患有双相情感障碍 (n=33/121)，并且查尔森合并症指数较低。与非储蓄者（3.73）相比，高成本储蓄者在基线期的抗抑郁药平均数量（平均值=3.16）较少，但高于低成本储蓄者（2.72）（各组p<0.05）。在多变量模型中，双相、抗抑郁药数量、门诊就诊和住院就诊在统计学上与高成本节省相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 与非储蓄者（3.73）相比，高成本储蓄者在基线期的抗抑郁药平均数量（平均值=3.16）较少，但高于低成本储蓄者（2.72）（各组p<0.05）。在多变量模型中，双相、抗抑郁药数量、门诊就诊和住院就诊在统计学上与高成本节省相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 与非储蓄者（3.73）相比，高成本储蓄者在基线期的抗抑郁药平均数量（平均值=3.16）较少，但高于低成本储蓄者（2.72）（各组p<0.05）。在多变量模型中，双相、抗抑郁药数量、门诊就诊和住院就诊在统计学上与高成本节省相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 16）与非储蓄者（3.73）相比，但高于低成本储蓄者（2.72）（各组p<0.05）。在多变量模型中，双相、抗抑郁药数量、门诊就诊和住院就诊在统计学上与高成本节省相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 16）与非储蓄者（3.73）相比，但高于低成本储蓄者（2.72）（各组p<0.05）。在多变量模型中，双相、抗抑郁药数量、门诊就诊和住院就诊在统计学上与高成本节省相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 住院就诊与高成本节省在统计学上相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind 住院就诊与高成本节省在统计学上相关；基线期的抗抑郁药计数和全因住院和门诊就诊与成本节约呈负相关。结论：在一家大型商业保险公司的数据库中，药物遗传学分析的使用与成本节约相关。与患有其他情绪和焦虑障碍的人相比，双相情感障碍患者更有可能节省高额费用。基金致谢：Genomind