Table 2:

Base-case results of pharmacogenomic-guided treatment, compared with current standard of care, for major depressive disorder (MDD) in British Columbia over a 20-year time horizon^*

Model output	Pharmacogenomic-guided treatment	Current standard of care	Incremental difference, total	Incremental difference, per patient
Outcomes
Life-years	3 079 575	3 067 139	12 436	0.064
QALYs	2 234 977	2 160 954	74 023	0.381
Costs, $†
Cost of episodic MDD care‡	6.23 billion	5.71 billion	524 million	2701
Cost of refractory MDD care§	2.61 billion	4.21 billion	−1.6 billion	−8251
Cost of pharmacogenomic testing	121 million	–	121 million	623
Total cost	8.96 billion	9.92 billion	−956 million	−4926
Pharmacogenomic-guided treatment v. current standard of care
Incremental cost per QALY	Cost-saving (dominant)
Incremental cost per life-year	Cost-saving (dominant)

Note: QALY = quality-adjusted life-year.

^*Closed cohort of patients with prevalent and newly diagnosed MDD (n = 194 149, mean age = 45.6 yr) in 2021 (20-yr time horizon, 1.5% discount rate, public payer perspective).

^†In 2020 Canadian dollars.

^‡The model assigns the costs to each patient at different time points as they experience different events along the clinical pathway. Includes the cost of different MDD treatments (pharmacotherapy, psychotherapy and electroconvulsive therapy), physician fees (MDD and non-MDD), all-cause hospital visits and the direct medical cost of suicide.

^§The model does not simulate a detailed care pathway for patients with refractory MDD. Instead, it assigns the average weekly cost of all health care of patients with refractory depression sourced from the BC administrative databases.^26–31 Includes the cost of different MDD treatments (pharmacotherapy, psychotherapy and electroconvulsive therapy), physician fees (MDD and non-MDD), all-cause hospital visits and the direct medical cost of suicide.