Economic effectiveness of pharmacogenomics-guided prescribing for psychiatric disorders: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.07 (total group), p = 0.17 (subgroup)

• Effect Size: £1,623.14 (total group), £41.54 (homogeneous subgroup)

• Primary Outcome: Incremental Net Benefit (INB) of PGx-guided prescribing vs standard care

• Nnt Or Sensitivity: 88% of individual studies favoured PGx-guided prescribing in narrative synthesis

• Confidence Interval: 95% CI: -£116.50 to £3,362.79 (total); -£18.27 to £101.35 (subgroup)

Clinical Application

Implementation requires access to pharmacogenomic testing, trained personnel, and integration with clinical decision support systems Relevant to Australian practice given PBS subsidisation considerations and RACGP interest in personalised medicine, though TGA approval status of specific PGx tests would need verification Adults with psychiatric disorders requiring pharmacological treatment, particularly those with treatment-resistant conditions or multiple medication trials

Abstract

Pharmacogenomics (PGx)-guided prescribing is a promising approach to reduce variability in drug response, although its cost-effectiveness remains uncertain. We performed a systematic review and meta-analysis evaluating the cost-effectiveness of PGx-guided prescribing compared to standard care in psychiatry. In January 2026, we searched MEDLINE, Embase and PsycINFO for studies published between 2014 and 2025. We included any peer-reviewed study that included adults with a diagnosed psychiatric disorder, comparing PGx-guided prescribing to standard care, and reported both quality-of-life and economic outcomes. Given the lack of consensus on synthesising economic evidence, both a narrative synthesis and meta-analysis were conducted. Pooled incremental net benefit (INB) was used as the effect measure for the meta-analysis and heterogeneity measures including the I2 test were used to assess heterogeneity and determine which model to use for the meta-analysis. From an initial 1 271 records, 17 studies were included. The narrative synthesis found that 88% of studies favoured PGx-guided prescribing. Meta-analyses produced positive, though non-significant, pooled Incremental Net Benefits (INBs) for the total study groups (£1 623.14, 95% CI: -£116.50 to £3 362.79, p = 0.07, I2 = 100%), and for a statistically homogeneous subgroup (£41.54, 95% CI: -£18.27 to £101.35, p = 0.17, I2 = 0%). Our review indicates that PGx-guided prescribing can be cost-effective in psychiatry but highlights the need for increased consensus in economic modelling methods.

References

1. 1.Mason, E. R., Ali, M. Y., Gibson, D. S., Murray, E. K., Burns, R. M., & Kelly, C. (2026). Economic effectiveness of pharmacogenomics-guided prescribing for psychiatric disorders: a systematic review and meta-analysis. The Pharmacogenomics Journal. https://doi.org/10.1007/s00213-017-4622-9